Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores

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Title   Declaración De Derechos Para Trabajador Totalmente Discapacitado Bajo El Programa De Compensación Y Beneficios Para Trabajadores (143 KB PDF)
Description Used by a totally permanently disabled worker. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits.
Detail
Form number F242-173-944
Availability
Online only. See document above to download.
Keywords claim information, claims, coverage, declaration, disability pension benefits, entitlement, industrial insurance, injured worker, injuries, injury, insurance, occupational injuries, pension disability benefits, social security offset, sso, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 11-2009
Contact information
Web pages Workers' Comp Claims

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