Request for Claim Information

Document Information
  How to complete a fillable form.
Title Request for Claim Information

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

Document number F101-010-111
How to get this document
Alt Language(s)
Valid dates 02/2014
Contact information Claims for Job Injuries , Managing Injured Workers' Claims , Self-Insurance
Websites Workers' Comp Claims

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