Forms and Publications

Search by:   for     

Browse By Subject  |  Most Requested  |  Required L&I Workplace Posters  |  Spanish Language Documents  |  Show all L&I Forms/Pubs


View:    Sort by:       
Title/Description:

Type:

Chapter 51.24 RCW Actions at Law for Injury or Death - Spanish Capítulo 51.24 Acciones Legales por Lesiones o Fallecimiento

Actualización de la Publicación de 2001 – Código Revisado de Washington (RCW, por su sigla en inglés) 51.24.060(6)(7).  Esta actualización cambia el requisito de entrega por correo registrado o certificado por ‘entrega por un método cuya recepción puede ser confirmada o localizada.'

 

 




F242-138-999



Alt Language(s):
Inglés
 
Chapter 51.24 RCW Actions at Law for Injury or Death - Spanish Capítulo 51.24 Acciones Legales por Lesiones o Fallecimiento

Actualización de la Publicación de 2001 – Código Revisado de Washington (RCW, por su sigla en inglés) 51.24.060(6)(7).  Esta actualización cambia el requisito de entrega por correo registrado o certificado por ‘entrega por un método cuya recepción puede ser confirmada o localizada.'

 

 




F242-138-999



Alt Language(s):
Inglés
 
Chapter 51.24 RCW Actions at Law for Injury or Death

Distribution of Amount Recovered—Lien (RCW 51.24.060).  Update to 2001 Publication – RCW 51.24.060(6)(7).  The PDF is 8 1/2" x 14" if you print a copy.




F242-138-111



Alt Language(s):
Español
 
Chapter 51.24 RCW Actions at Law for Injury or Death

Distribution of Amount Recovered—Lien (RCW 51.24.060).  Update to 2001 Publication – RCW 51.24.060(6)(7).  The PDF is 8 1/2" x 14" if you print a copy.




F242-138-111



Alt Language(s):
Español
 
Chapter 51.24 RCW Actions at Law for Injury or Death

Distribution of Amount Recovered—Lien (RCW 51.24.060).  Update to 2001 Publication – RCW 51.24.060(6)(7).  The PDF is 8 1/2" x 14" if you print a copy.




F242-138-111



Alt Language(s):
Español
 
Injured by a third party?  

Brochure: Summarizes the legal rights and options an injured worker has if a third-party action pertains to his/her workers' compensation claim. Includes the Third Party Election Form that must be completed by the worker. Note: The form must be printed, signed and mailed.



Form
F249-008-000



Alt Language(s):
Español
 
Injured by a third party?  

Brochure: Summarizes the legal rights and options an injured worker has if a third-party action pertains to his/her workers' compensation claim. Includes the Third Party Election Form that must be completed by the worker. Note: The form must be printed, signed and mailed.



Publication
F249-008-000



Alt Language(s):
Español
 
Inquiry for Assessment of Damages

Your answers to these questions will be used to assist in evaluating your damages if a claim is made against a liable third party.



Form
F242-067-000



Alt Language(s):
Español
 
Know What to Expect: How Recoveries and Settlements May Impact Your Crime Victim Claim

Pamphlet and form: Explains third-party liability, recoveries and settlements. A crime victim or the Crime Victims Compensation Program may pursue monetary restitution from someone who caused or contributed to a crime victim's injury. Explains the purpose of the form and why individuals who file a crime victims claim are required to complete it.



Publication
F800-074-000


 
Self-Insurance Electronic Data Reporting System (SIEDRS) Enrollment Form
Used by self-insured employers and third party administrators to enroll for participation in the Self Insurance Electronic Data Reporting System (SIEDRS). F207-197-000 is SIEDRS (Self-Insurance Electronic Data Reporting System) Data Change Request.

Form
F207-193-000


 
Supplemental Agreement Third Party Pharmacy Provider
This agreement is to define access, performance and legal requirements for third party pharmacy billers who submit bills to and receive payment from L&I on behalf of pharmacy providers. This agreement authorizes L&I to accept and remit monies due the Pharmacy using a third party pharmacy biller.

Form
F249-021-000


 
Supplemental Agreement Third Party Pharmacy Provider
This agreement is to define access, performance and legal requirements for third party pharmacy billers who submit bills to and receive payment from L&I on behalf of pharmacy providers. This agreement authorizes L&I to accept and remit monies due the Pharmacy using a third party pharmacy biller.

Form
F249-021-000


 





End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.