Request for Claim Information

Request for Claim Information - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Request for Claim Information (A fillable form - 171 KB PDF)
Description

Used by workers, workers' representatives, employers or employers' representatives to request claim information from L&I.

Detail
Form number F101-010-111
Availability
Online only. See document above to download.
Keywords claims, file, industrial insurance, release information, self insurance, self insurer, self-insurance, self-insurer, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 02-2000
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Self-Insurance
Web pages Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.