Application for Group Retrospective Rating

Application for Group Retrospective Rating - (Forms/Publications)
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Title Application for Group Retrospective Rating (A fillable form - 276 KB PDF)
Description Used by organizations to set up an agreement with L&I authorizing their participation in retrospective rating.
Form number F250-004-000
Online only. See document above to download.
Keywords industrial insurance, reducing premiums, retro, worker's compensation, workers compensation, workers' compensation
Languages English
Valid dates 04-2012 , Mo-2011
Contact information Contact Us About Retrospective Rating
Related information
Documents Application for Group Membership & Authorization for Release of Insurance Data
Web pages Qualify for Refunds

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