SIF-4 Self Insured Employer's Request for Denial of Claim

SIF-4 Self Insured Employer''s Request for Denial of Claim - (Forms/Publications)
Document Information
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Title SIF-4 Self Insured Employer''s Request for Denial of Claim (A fillable form - 61 KB PDF)
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.
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
Web pages Insurance for Business
Self-Insured Employers

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