SIF-4 Self Insured Employer's Request for Denial of Claim
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
SIF-4 Self Insured Employer's Request for Denial of Claim (A fillable form - 61 KB PDF)
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| Description | Used by self-insured employers or their representatives to notify an injured worker that the employer or representative is requesting that L&I deny their claim. | |
| Detail | ||
| Form number | F207-163-000 | |
| Availability | Online only. See document above to download. |
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| Keywords | claims, denial notice, industrial insurance, injuries, injury, notice of denial, notice of rejection, rejection notice, self insurance, self insurer, self-insurance, self-insurer, sif 4, sif4, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 10-2008 | |
| Contact information |
Managing Injured Workers' Claims
Claims for Job Injuries Self-Insurance |
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| Web pages | Insurance for Business Self-Insured Employers |
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