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Results for: Claims and Insurance - Third Party Claims
Title Number / Language
Declaration of Entitlement - Disabled Child or Guardian Benefits  F242-421-000 (English)
 F242-421-999 (Spanish)
Declaration of Entitlement - Surviving Spouse/Registered Domestic Partner  F242-420-000 (English)
 F242-420-999 (Spanish)
Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance  F242-422-000 (English)
 F242-422-999 (Spanish)
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance  F242-423-000 (English)
 F242-423-999 (Spanish)
Employer's Job Description  F252-040-000 (English)
3 Things to Know about L&I's Medical Provider Network  F242-406-000 (English)
 F242-406-999 (Spanish)
A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses  F207-085-000 (English)
 F207-085-999 (Spanish)
Accountability Agreement  F280-016-000 (English)
Acknowledgement of Security Interest  F207-143-000 (English)
Actions at Law for Injury or Death - RCW 51.24  F249-031-000 (English)
 F249-031-999 (Spanish)
Activity Prescription Form (APF)  F242-385-000 (English)
Address Change Request for Injured Workers  F242-388-000 (English)
 F242-388-999 (Spanish)
Address Change Request for Pensioners  F242-107-000 (English)
 F242-107-999 (Spanish)
Affidavit for Time Loss Compensation Benefits  F242-395-000 (English)
 F242-395-999 (Spanish)
Agreement - Farm Labor Contractors and Workers  F700-046-000 (English)
 F700-046-999 (Spanish)
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities (Certified Self-Insurer)  F207-040-001 (English)
Agreement of Assumption and Guarantee of Workers' Compensation Liabilities - Application of Certification  F207-040-000 (English)
Amendment of Irrevocable Standby Letter of Credit  F207-112-111 (English)
An Employer's Intro to L&I  F101-101-000 (English)
Annual Supplemental Surety Information  F207-125-000 (English)
Application for Benefits - Crime Victims  F800-042-000 (English)
 F800-042-999 (Spanish)
Application for Benefits - Homicide Claims  F800-120-000 (English)
 F800-120-999 (Spanish)
Application for Construction Contractor Registration  F625-001-000 (English)
Application for Elective Coverage - Sole Proprietor, Partners, For-Profit Corporate Officers, or Member/Managers of Limited Liability Company (LLC)  F213-042-000 (English)
Application for Elective Coverage of Excluded Employments  F213-112-000 (English)
Application for Exclusion/Inclusion - Mandatory Coverage (Family Farm)  F213-113-000 (English)
Application for Group Membership & Authorization for Release of Insurance Data  F250-016-000 (English)
Application for Group Retrospective Rating  F250-004-000 (English)
Application for Inclusion on List of Eligible Attorneys  F249-017-000 (English)
Application for Limited Elective Coverage for Licensed Pony Riders  F250-026-000 (English)
Application for Loss of Earning Power Compensation Medical  F242-208-909 (English/Spanish)
 F242-208-999 (Spanish)
Application for Loss of Earning Power Vocational  F242-209-909 (English/Spanish)
 F242-209-999 (Spanish)
Application for out of State Supplemental Reporting  F212-234-000 (English)
Application for Pension Benefits by Spouse or Children  F242-391-000 (English)
 F242-391-999 (Spanish)
Application for Self-Insurance Certification  F207-001-000 (English)
Application for Structured Settlement  F240-002-000 (English)
 F240-002-999 (Spanish)
Application for Loss of Earning Power (LEP) - Compensation Medical  F242-208-000 (English)
Application to Reopen Claim Due to Worsening Condition  F242-079-000 (English)
Application to Reopen Claim due to Worsening Condition  F242-079-999 (Spanish)
Application to Reopen Crime Victim Claim Due to Worsening of Condition  F800-031-000 (English)
 F800-031-999 (Spanish)
Application for Loss of Earning Power (LEP) - Vocational  F242-209-000 (English)
Approved Independent Medical Examiner (IME) Update  F245-051-000 (English)
Are You an Employer Who Can Provide On-the-Job Training?  F280-033-000 (English)
Assessing Your Ability to Work: Your Rights and Responsibilities  F280-017-000 (English)
 F280-017-999 (Spanish)
Assessment Eligible Quality Assurance Review Form  F280-008-000 (English)
Assignment of Account Agreement  F207-058-000 (English)
Attending Doctor's Handbook  F252-004-000 (English)
Attending Provider's Referral Form  F252-098-000 (English)
Attending Provider's Return-to-Work Desk Reference  F200-002-000 (English)
Audit Reference Card  F214-020-000 (English)
Authorization to Release Claim Information  F101-010-000 (English)
Authorization to Release Information  F262-005-000 (English)
 F262-005-999 ()
Avoid Liability for Your Farm Labor Contractor's Unpaid Debits  F700-154-909 (English/Spanish)
Avoid Liability for Your Subcontractor's Unpaid Workers' Comp Premiums  F262-262-000 (English)
 F262-262-999 (Spanish)
Billing Guidelines for Sexual Assault Examinations: Crime Victims Compensation Program  F800-100-000 (English)
Buprenorphine Transdermal Patch Authorization Request Form  F252-110-000 (English)
Business and Industry Category Guide  F250-025-000 (English)
Cancellation of Elective Coverage - Sole Proprietors/Partner, Member of Limited Liability Company (LLC), Member of Limited Liability Partnership (LLP) or For-Profit Corporate Officers  F213-004-000 (English)
Cancellation of Elective Coverage for Excluded Employments  F213-005-000 (English)
Carrying Out Your Vocational Plan: Your Rights and Responsibilities During Plan Implementation  F280-019-000 (English)
 F280-019-999 (Spanish)
Certificate of Coverage - SAMPLE ONLY  F211-141-000 (English)
 F211-141-999 (Spanish)
Chapter 51.24 RCW Actions at Law for Injury or Death - Spanish Capítulo 51.24 Acciones Legales por Lesiones o Fallecimiento  F242-138-999 (Spanish)
Checklist for IME Facilities  F245-421-000 (English)
Chemical Exposure Questionnaire Packet  F242-409-000 (English)
 F242-409-999 (Spanish)
Chronic Opioid Request Form  F252-091-000 (English)
Claim for Pension By Dependents  F242-062-000 (English)
 F242-062-999 (Spanish)
Claim for Pension by Spouse or Children  F242-056-000 (English)
 F242-056-999 (Spanish)
Claim Suppression Complaint  F262-024-000 (English)
 F262-024-999 (Spanish)
CMS 1500  F245-127-000 (English)
CMS 1500 Billing Manual  F245-423-000 (English)
Common Errors on the Interpretive Services Appointment Record (ISAR)  F245-436-000 (English)
Complete Stay at Work Guide for Employers, The  F243-005-000 (English)
Computing Worker Hours  F214-014-000 (English)
Congratulations! You've been approved to hire minors  F700-136-000 (English)
Construction Contractor's Application for Workers' Compensation Account with No Workers or Hours  F625-077-000 (English)
Construction Industry Classification Guide  F213-008-000 (English)
 F213-008-999 (Spanish)
Contract: Report By Contractor - Forest, Range & Timber Industry  F213-011-000 (English)
Contract: Report By Landowner - Forest, Range & Timber Industry  F213-010-000 (English)
Corporate Officers  F214-010-000 (English)
Coverage Agreement  F212-044-000 (English)
Crime Victim Compensation Program Sexual Assault Exam Report  F800-098-000 (English)
Crime Victims Address Change Request  F800-112-000 (English)
Crime Victims Compensation Physical Abuse/Neglect Exam Report  F800-121-000 (English)
Crime Victims Compensation Program Initial Response and Assessment: Form I  F800-080-000 (English)
Crime Victims Compensation Program Initial Response and Assessment: Form II  F800-081-000 (English)
Crime Victims Compensation Program Progress Note: Form III  F800-082-000 (English)
Crime Victims Compensation Program Termination Report: Form VI  F800-085-000 (English)
Crime Victims Compensation Program Treatment Report: Form IV  F800-083-000 (English)
Crime Victims Compensation Program Treatment Report: Form V  F800-084-000 (English)
Crime Victims Compensation Subacute Opioid Request Form  F800-119-000 (English)
Crime Victims Direct Entry Billing Manual  F800-118-000 (English)
Crime Victims Statement for Home Nursing Services  F800-070-000 (English)
Crime Victims Statement for Pharmacy Services  F800-058-000 (English)
Crime Victims Provider's Request for Adjustment  F800-064-000 (English)
Crime Victims' Statement for Compound Prescription  F800-067-000 (English)
CVCP Opioid Progress Report Chronic, Non-Cancer Pain and Treatment Agreement.  F800-116-000 (English)
Department of Labor and Industries Home Modification Acknowledgement of Responsibilities  F247-003-000 (English)
 F247-003-999 ()
Development of the plan: What are my rights and responsibilities? Vocational Rehabilitation Services  F280-018-999 (Spanish)
Direct Entry Billing Manual  F245-437-000 (English)
Direct-Acting Antiviral for Hepatisis C Prior Authorization Form  F252-112-000 (English)
Doctor's Worksheet for Rating Cervical and Cervico-Dorsal Impairment  F252-056-000 (English)
Doctor's Worksheet for Rating Dorso-Lumbar & Lumbo-Sacral Impairment  F252-006-000 (English)
Doing Business with the State of Washington: A Guide to Washington State Bid Opportunities  F101-087-000 (English)
Drywall Contractors  F214-024-000 (English)
Drywall Industry - Owner/Sub-Contractor Report  F212-050-000 (English)
Electronic Billing Authorization  F248-031-000 (English)
Employee Misconduct: Information for Employers  F417-254-000 (English)
Employer's Return-to-Work Guide  F200-003-000 (English)
Employers' Guide to Self-Insurance in Washington State  F207-079-000 (English)
Employers' Guide to Workers' Compensation Insurance in Washington State  F101-002-000 (English)
 F101-002-999 (Spanish)
Employment History Form  F242-109-000 (English)
 F242-109-999 (Spanish)
Evaluating Retro Groups  F225-019-000 (English)
Excluded and Exempt Employments  F214-013-000 (English)
F245-392-000 Resource Utilization Group (RUG) Residential Care Services for L&I Injured Workers (In place of MDS 3.0 beginning October 1, 2010.)  F245-392-000 (English)
FileFast postcard handout for workers  F242-398-000 (English)
FileFast poster for workers  F242-399-000 (English)
FileFast wallet card for workers  F242-400-000 (English)
Financial Statement Businesses  F215-040-000 (English)
Financial Statement Sole Proprietors and Individuals  F215-039-000 (English)
Firm Vocational Provider Account Change  F252-022-000 (English)
Frequently Asked Questions about Job Modifications  F245-057-000 (English)
Functional Capacity Summary  F245-434-000 (English)
Functional Recovery Interventions Tracking Sheet  F245-420-000 (English)
General Provider Billing Manual  F248-100-000 (English)
Getting Back to Work: It's Your Job and Your Future  F200-001-000 (English)
 F200-001-999 (Spanish)
Getting up-to-speed on regulations for Washington businesses?  F101-174-000 (English)
Group vs. Individual Retrospective Rating Participation  F225-016-000 (English)
Have you been injured at work?  F242-404-999 (Spanish)
Hearing Aid Repair/Durable Medical Equipment Provider Hotline Service Authorization Request  F245-418-000 (English)
Hearing Aid Replacement Form  F242-414-000 (English)
Hearing Impairment Calculation Worksheet  F252-007-000 (English)
Hearing Services Worker Information  F245-049-000 (English)
Help for Crime Victims (large poster)  F800-041-000 (English)
 F800-041-999 (Spanish)
Help for Crime Victims (small poster)  F800-104-000 (English)
 F800-104-999 (Spanish)
Help for Injured Workers of Self-Insured Employers  F207-213-000 (English)
 F207-213-999 (Spanish)
Help for Victims of Crime  F800-006-909 (English/Spanish)
Helping Providers Understand the Crime Victims Compensation Program  F800-102-000 (English)
Home Health Services Billing Manual  F245-424-000 (English)
Home Modification for Workers with Catastrophic Injuries  F252-060-000 (English)
 F252-060-999 (Spanish)
Home Modification for Workers with Catastrophic Injuries - Questions and Answers for Contractors  F252-061-000 (English)
 F252-061-999 (Spanish)
Hospital Services Billing Manual  F245-425-000 (English)
Hotline Tips for Medical Services Providers  F248-040-000 (English)
How Social Security Benefits May Reduce Your Workers' Compensation Payments  F242-427-000 (English)
How to Protest a Department of Labor and Industries Decision  F242-363-909 (English/Spanish)
IME Provider Renewal Application  F245-435-000 (English)
Independent Contractor Guide: A Step-by-Step Guide to Hiring Independent Contractors in Washington State  F101-063-000 (English)
 F101-063-999 (Spanish)
Independent Contractor or Covered Worker? - Your rights to workers' compensation, minimum wage and overtime  F212-250-000 (English)
 F212-250-999 (Spanish)
Independent Contractors  F214-012-000 (English)
Independent Medical Exam Comments  F245-053-000 (English)
 F245-053-999 (Spanish)
Independent Medical Exam Doctor's Estimate of Physical Capacities  F242-387-000 (English)
Independent Medical Exam Template  F245-058-000 (English)
Independent Medical Examination (IME) Provider Exam Sites  F245-047-000 (English)
Independent Medical Examination Fax Cover Sheet  F245-383-000 (English)
Individual Retrospective Rating Plan Agreement  F250-003-000 (English)
Individual Vocational Provider Account Change Form  F252-021-000 (English)
Industrial Insurance Discrimination Complaint  F262-009-000 (English)
 F262-009-999 (Spanish)
Injured by a third party?  F249-008-000 (English)
 F249-008-999 (Spanish)
Injured Workers: Leaving Washington, But Still Need Treatment  F242-412-909 (English/Spanish)
Inquiry for Assessment of Damages  F242-067-000 (English)
Instructions for completing the Workers' Compensation Employer's Quarterly Report  F212-239-000 (English)
International Travel for Work  F242-419-000 (English)
Interpreter Services for Injured Workers and Crime Victims  F245-412-000 (English)
 F245-412-999 (Spanish)
Interpretive Services Appointment Record (ISAR)  F245-056-000 (English)
Irrevocable Standby Letter of Credit  F207-112-000 (English)
Is Retrospective Rating Right for You?  F250-006-000 (English)
Job Analysis  F252-072-000 (English)
Job Analysis Summary  F252-101-000 (English)
Job Modification Assistance Application  F245-346-000 (English)
 F245-346-999 (Spanish)
Keys to Retro Success  F225-018-000 (English)
Know What to Expect: How Recoveries and Settlements May Impact Your Crime Victim Claim  F800-074-000 (English)
L&I Benefits for Workers Who Are Terminally Ill  F252-094-000 (English)
L&I Chiropractic Consultant Application  F245-393-000 (English)
Labor and Industries Prosthetic Device Request Form  F245-340-000 (English)
Legal Representation Notification  F242-425-000 (English)
 F242-425-999 (Spanish)
Legal Representative Payment Method Authorization Form  F120-212-000 (English)
Letter of Intent for School Enrollment  F242-382-000 (English)
 F242-382-999 (Spanish)
Limited Liability Companies (LLC)  F214-021-000 (English)
Long Term Care Assessment Tool  F245-377-000 (English)
Maritime Coverage  F212-034-000 (English)
Massage Therapist: Independent Contractor or Covered Worker?  F212-248-000 (English)
Master Level Counselor Provider Account Application for Crime Victims  F800-053-000 (English)
Mechanized Logging Supplemental Quarterly Report  F212-223-000 (English)
Medical Device Review Request  F252-013-000 (English)
Medical Examiners' Handbook  F252-001-000 (English)
Medical Payment Guidance  F248-366-000 (English)
Memorandum of Understanding  F207-129-000 (English)
Memorandum of Understanding Irrevocable Standby Letter of Credit  F207-113-000 (English)
Mental Health Fee Schedule and Billing Guidelines  F800-105-000 (English)
Miscellaneous Services Billing Manual  F245-431-000 (English)
Non-Accredited or Unlicensed Training Provider Application Supplemental Requirements  F280-045-000 (English)
Non-Network Provider Application  F248-011-000 (English)
Notice of Completion of Public Works Contract  F215-038-000 (English)
Notice of Independent Medical Exam No-Show or Late Cancellation  F245-382-000 (English)
Notice of Occupational Disease or Infection  F242-243-000 (English)
Notice to Employees - If a Job Injury Occurs  F207-037-909 (English/Spanish)
Notice to Employees -- If a Job Injury Occurs  F242-191-909 (English/Spanish)
Occupational Disease & Employment History  F242-071-000 (English)
 F242-071-911 (Spanish)
 F242-071-999 (Spanish)
Occupational Disease Employment History Hearing Loss  F262-013-000 (English)
 F262-013-999 (Spanish)
Occupational Disease Work History - Continuation  F242-071-111 (English)
Occupational Hearing Loss Questionnaire  F262-016-000 (English)
 F262-016-999 (Spanish)
OJT Information Request and Recommendation form  F280-032-000 (English)
On-the-Job Training  F200-021-000 (English)
On-The-Job Training (OJT) Agreement for Vocational Providers  F280-039-000 (English)
Opioid Treatment Agreement  F252-095-000 (English)
 F252-095-999 (Spanish)
Option 1 Plan Modification Accountability Agreement  F280-056-000 (English)
Option 2 Vocational Benefits Training Enrollment Application  F280-024-909 (English/Spanish)
Option 2 Vocational Benefits Training Enrollment Application and Verification  F280-024-000 (English)
Option 2: What You Need to Know, Vocational Rehabilitation Services  F280-036-000 (English)
 F280-036-999 (Spanish)
Out of Country Provider Application  F248-361-000 (English)
 F248-361-999 (Spanish)
Overpayment Reimbursement Fund Request Coversheet  F207-212-000 (English)
Payment Method Authorization  F120-211-000 (English)
 F120-211-999 (Spanish)
Payroll Service Provider - Quarterly Reporting Bulk Filing Enrollment Form  F248-343-000 (English)
Pension and Survivor Benefits in Washington State's Workers' Compensation Program  F242-352-909 (English/Spanish)
Pension Benefits Questionnaire  F242-393-000 (English)
 F242-393-999 (Spanish)
Pension Bond Rider  F207-120-000 (English)
Performance Based Physical Capacities Evaluation  F245-023-000 (English)
Pharmacy Billing Manual  F245-433-000 (English)
Pharmacy Companion Guide  F245-400-000 (English)
Physical Therapy / Occupational Therapy Progress Report to Claim Managers  F245-059-000 (English)
Physical/Occupational/Massage Therapy Provider Hotline Service Authorization Request  F245-417-000 (English)
Plan Development Quality Assurance Review Form  F280-007-000 (English)
Plan Development: What Are My Rights & Responsibilities?  F280-018-000 (English)
Plan for and Pay Your Taxes DVD  F101-091-034 (English)
Plan Room and Board Cost Encumbrance  F245-372-000 (English)
Pocket Guide to Worker Rights  F101-165-000 (English)
 F101-165-909 (English/Spanish)
Power of Attorney for Electronic Remittance Advice  F248-355-000 (English)
Pre-Audit Questionnaire  F213-177-000 (English)
Pre-Job Accommodation Assistance Application  F245-350-000 (English)
Preauthorization Request for Services for State Fund Workers' Compensation Patients  F242-397-000 (English)
Preferred Drug Line Prescription Authorization Request  F245-419-000 (English)
Preferred Worker Expense Reimbursement - Application for Employers (Tools & Clothing)  F280-058-000 (English)
Preferred Worker Program  F280-021-000 (English)
 F280-021-999 (Spanish)
Preferred Worker Request  F280-060-000 (English)
Preferred Worker Wage Reimbursement Application for Employers  F280-059-000 (English)
Preparing for Your Self-Insurance Audit  F207-110-000 (English)
Protesting Retro Adjustments  F250-027-000 (English)
Provider Account Application - Independent Medical Examiner (IME)  F245-046-000 (English)
Provider Change Form for Crime Victims Compensation  F800-089-000 (English)
Provider General Billing Manual  F245-432-000 (English)
Provider Network Agreement  F245-397-000 (English)
Provider Payment Account Change Form  F245-365-000 (English)
Provider's Initial Report (PIR)  F207-028-000 (English)
Provider's Request for Adjustment  F245-183-000 (English)
PT/OT Referral Form  F252-099-000 (English)
Quarterly Report for Self-Insured Business  F207-006-000 (English)
Quarterly Reporting for Drywall  F212-224-000 (English)
Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers  F207-011-000 (English)
Quick Reference Card for Providers 2015  F245-414-000_2015 (English)
Quick Reference Card for Providers 2016  F245-414-000_2016 (English)
QuickFile: Workers' Compensation Quarterly Report Filing Made Easy!  F212-244-000 (English)
Record Keeping  F214-011-000 (English)
Referral for Activity Coaching Program  F245-413-000 (English)
Referral to Labor and Industries /WorkSource Partnership Services  F280-046-000 (English)
Reforestation Contract Supplemental Report - Forest, Range and Timber Industry  F213-013-000 (English)
Reforestation Industry Continuation Sheet (Over $10,000)  F213-015-000 (English)
REFUND NOTIFICATION Refunding Money to L&I to correct your account?  F245-043-000 (English)
Report of Accident (ROA) Workplace Injury, Accident or Occupational Disease  F242-130-000 (English)
Request for Claim Information  F101-010-111 (English)
 F101-010-999 (Spanish)
Request for Survivor Counseling Benefits  F800-057-909 (English/Spanish)
Resume Cover Sheet  F242-418-000 (English)
Retraining and Job Modification Billing Manual  F245-427-000 (English)
Retrospective Rating Adjustment Protest  F250-024-000 (English)
Retrospective Rating Enrollment Decisions  F225-017-000 (English)
Sample Format for Vocational Testing Report  F252-051-000 (English)
Sample Self-Employment Agreement  F252-032-000 (English)
Schedule of Future Payments for the Balance of the Permanent Partial Disability Award  F207-162-000 (English)
Seasonal Group Variance Application  F700-135-000 (English)
Self Insurance Continuing Education Report of Course Completion  F207-191-000 (English)
Self Insurance Continuing Education Sponsor/Instructor Application for Course Approval  F207-192-000 (English)
Self-Insurance Certification Questionnaire  F207-176-000 (English)
Self-Insurance Continuing Education Application for Course Approval and Attendance  F207-206-000 (English)
Self-Insurance Electronic Data Reporting System (SIEDRS) Enrollment Form  F207-193-000 (English)
Self-Insurance Electronic Data Reporting System (SIEDRS): Enrollment Package 2.0  F207-194-000 (English)
Self-Insurance Medical Provider Billing Dispute Form  F207-207-000 (English)
Self-Insurance Option 2 Vocational Services Summary Form  F280-064-000 (English)
Self-Insurance Report of Occupational Injury or Disease (SIF-5)  F207-005-000 (English)
Self-Insurance Vocational Reporting Form  F207-190-000 (English)
Self-Insurance Vocational Services Closing Cover Sheet  F207-171-000 (English)
Self-Insured Employer Certificate of Excess Insurance  F207-095-000 (English)
Self-Insured Employers' Medical Only Claim Closure Order and Notice  F207-020-111 (English)
 F207-020-999 (Spanish)
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-NTL  F207-165-000 (English)
 F207-164-999 (Spanish)
 F207-165-999 (Spanish)
Self-Insured Employers' Permanent Partial Disability Closure Order and Notice - PPD-TL  F207-164-000 (English)
Self-Insured Employers' Time Loss Claim Closure Order and Notice  F207-070-000 (English)
 F207-070-999 (Spanish)
Self-Insurer Accident Report (SIF-2)  F207-002-000 (English)
Self-Insurer's Bond - Existing Liabilities  F207-068-000 (English)
Self-Insurer's Pension Bond  F207-065-000 (English)
Settling your injured worker's L&I claim: A new option for injured workers 50 and older  F240-004-000 (English)
Settling your L&I claim might be right for you: An option for injured workers 50 or older  F240-003-000 (English)
 F240-003-999 (Spanish)
SIEDRS (Self-Insurance Electronic Data Reporting System) Data Change Request  F207-197-000 (English)
SIF-4 Self Insured Employer's Request for Denial of Claim  F207-163-000 (English)
SIF-5A Cover Sheet: Wage Calculations  F207-156-000 (English)
Small Business Liaison Info Card  F101-088-000 (English)
Special Escrow Account - Amendment Agreement  F207-137-000 (English)
Special Escrow Agreement  F207-039-000 (English)
Sports Player Coverage Agreement  F212-242-000 (English)
Sports Teams Coverage Agreement  F212-196-000 (English)
Standard Exception Classification  F214-016-000 (English)
State Fund Option 2 Vocational Services Summary Form  F280-063-000 (English)
Statement for Compound Prescription  F245-010-000 (English)
Statement for Crime Victim Miscellaneous Services  F800-076-000 (English)
Statement for Crime Victims Mental Health Services  F800-025-000 (English)
Statement for Home Nursing Services  F248-160-000 (English)
Statement for Miscellaneous Services  F245-072-000 (English)
 F245-072-999 (Spanish)
Statement for Pharmacy Services  F245-100-000 (English)
Statement for Retraining and Job Modification Services  F245-030-000 (English)
 F245-030-999 (Spanish)
Statewide Payee Registration and W-9 Form  F248-036-000 (English)
Statewide Payee Registration and W-9 Form Crime Victims  F800-065-000 (English)
Stay at Work Exam Room Card  F243-009-000 (English)
Stay at Work Expense Reimbursement Application for Employers Tools, Clothing, Training.  F243-003-000 (English)
Stay at Work Wage Reimbursement Application for Employers  F243-001-000 (English)
Stay at Work: A new program to help employers keep injured workers on the job--pays half the wage plus expenses  F243-006-000 (English)
 F243-006-999 (Spanish)
Stop illegal contracting: See it? Report it.  F625-114-000 (English)
 F625-114-999 (Spanish)
Stop Work Payroll Report  F262-043-000 (English)
Structured Settlement Income and Expense Worksheet  F240-007-000 (English)
Student Volunteers and Workers' Compensation Coverage  F213-023-000 (English)
Subacute Opioid Request Form  F252-097-000 (English)
Submission of Provider Credentials for Interpretive Services  F245-055-000 (English)
Supplemental Agreement Third Party Pharmacy Provider  F249-021-000 (English)
Supplemental Quarterly Report for the Drywall Industry  F212-051-000 (English)
Surety Rider  F207-134-000 (English)
Teens at Work: Facts for Employers, Parents and Teens  F700-022-000 (English)
 F700-022-999 (Spanish)
Temporary Services Guide to Workers' Compensation Insurance  F213-019-000 (English)
Termination of Agreement (Rescission)  F245-050-000 (English)
The ABCs of Classifications in Washington  F213-022-000 (English)
Third Party Recovery Worksheet  F249-006-111 (English)
Time Encumbrance Form  F245-376-000 (English)
Training Plan Cost Encumbrance  F245-374-000 (English)
Transfer of Attending Provider Form for Self Insured Workers  F207-114-000 (English)
 F207-114-999 (Spanish)
Transfer of Care Card  F245-037-000 (English)
 F245-037-999 (Spanish)
Transportation Cost Encumbrance  F245-375-000 (English)
Travel Reimbursement Request  F245-145-000 (English)
 F245-145-999 (Spanish)
Travel Reimbursement Request - Crime Victims  F800-049-000 (English)
UB04 HCFA 1450  F245-367-000 (English)
Understanding Your Functional Capacity Evaluation  F245-416-000 (English)
 F245-416-999 (Spanish)
Verification of School Enrollment  F242-055-000 (English)
 F242-055-999 (Spanish)
Victim Verification Form  F800-110-000 (English)
 F800-110-999 (Spanish)
Vocational Provider Application  F252-088-000 (English)
Vocational Questionnaire/Work History  F280-038-000 (English)
 F280-038-999 (Spanish)
Vocational Technical Stakeholder Group (VTSG) Application  F280-049-000 (English)
Vocational Training Plan Ownership Agreement for Tools and Equipment  F245-351-000 (English)
 F245-351-999 (Spanish)
Wage-and-Hour Questions Employers Often Ask  F700-150-000 (English)
Washington Practitioner Application  F245-411-000 (English)
Washington Workers Insured Out-of-State: Employer's Supplemental Quarterly Report for Workers' Compensation  F212-233-000 (English)
What Are Your Rights as a Worker?  F101-061-909 (English/Spanish)
 F101-061-404 (English/Russian)
 F101-061-505 (English/Vietnamese)
 F101-061-606 (English/Cambodian)
 F101-061-707 (English/Korean)
When a Loved One Dies at Work  F417-240-000 (English)
 F417-240-999 (Spanish)
Work Status Form (formerly Worker Verification Form)  F242-052-000 (English)
 F242-052-999 (Spanish)
Worker Request for Union Dispatch Records  F242-410-000 (English)
 F242-410-999 (Spanish)
Workers' Comp Fraud Hurts YOU  F262-279-000 (English)
Workers' Compensation Benefits: A Guide for Injured Workers  F242-104-000 (English)
 F242-104-999 (Spanish)
Workers' Compensation Coverage for Wineries  F212-249-000 (English)
Workers' Compensation Discrimination  F262-249-909 (English/Spanish)
Workers' Compensation Employer's Quarterly Report  F212-055-000 (English)
Workers' Compensation Filing Information  F207-155-000 (English)
 F207-155-999 (Spanish)
Workers' Compensation Record Keeping and Reporting Guides  F212-222-000 (English)
 F212-222-999 (Spanish)
Workers' Compensation Requirements for the Marijuana Industry  F242-415-000 (English)
Workers: Activity coaching can help you get back to doing what you love  F280-061-000 (English)
 F280-061-999 (Spanish)
Your Independent Medical Exam  F245-224-000 (English)
 F245-224-999 (Spanish)
Your Independent Medical Exam (IME): Crime Victims Compensation Program  F800-115-000 (English)
Your Independent Medical Exam: For Employees of Self-Insured Businesses  F207-202-000 (English)
 F207-202-999 (Spanish)
Your Premium Dollars at Work (2014)  F200-023-000 (English)
Your Premium Dollars at Work (2015)  F200-025-000 (English)
Your Premium Dollars at Work (2016)  F200-027-000 (English)
Your Workers' Compensation Rate Notice - SAMPLE ONLY  F225-004-000 (English)





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