Washington State Department of Labor and Industries Forms

This form is used for applying to reopen a claim in the state of Washington when there has been a worsening of a medical condition.

This Form is used for requesting an allowance claim in the state of Washington. Fill out the form to submit your claim and receive the applicable allowance.

This Form is used for requesting a review of a claim denial in the state of Washington.

This form is used for making an interlocutory request in the state of Washington.

This Form is used for requesting overpayment refunds in Washington state.

This form is used for keeping track of future payments for the balance of a permanent partial disability award in the state of Washington.

This form is used for planning and tracking time, cost, and travel expenses for encumbrances in the state of Washington.

This document is used for self-insured employers in Washington to formally close a medical-only claim and notify the parties involved.

This Form is used for requesting the closure of a claim in Washington state.

Este formulario se utiliza para notificar la decisión de cierre con discapacidad parcial permanente a los empleadores autoasegurados en Washington.

This form is used for self-insured employers in Washington state to issue a closure order and notice for permanent partial disability cases. It must be completed and submitted to the appropriate authorities.

This form is used for self-insured employers in Washington to officially close a time-loss claim and notify the employee.

This Form is used for notifying employers who are self-insured in Washington about the decision to close a claim for lost time. (Spanish)

This document is used for notifying self-insured employers in Washington about permanent partial disability closure orders and provides relevant information regarding the closure process.

This type of document is a Self-insurance Certification Questionnaire specific to the state of Washington. It is used to certify self-insurance for certain types of insurance required by businesses in Washington.

This form is used for applying to become a self-insurance sponsor or instructor in Washington and obtain course approval for continuing education in the insurance industry.

This form is used for applying and getting approved for continuing education credits for self-insurance in Washington.

This form is used for applying to become a practitioner in Washington state.

This Form is used for filing health insurance claims in Washington state.

This Form is used for applying for an Ime Firm Provider Account in Washington.

This form is used for applying for a new or additional payee for an IME provider account in Washington.

This form is used for reporting complaints of provider fraud in the state of Washington.

This Form is used for reporting the progress of physical medicine treatment in the state of Washington.