Request for Claim Information

Request for Claim Information - (Forms/Publications)
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Title Request for Claim Information (A fillable form - 171 KB PDF)

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

Form number F101-010-111
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
Web pages Workers' Comp Claims

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