Get F242 079 000 Form

This guide provides a detailed walkthrough for users on how to complete the F242 079 000 Form effectively online. By following these steps, you can ensure that your application to reopen your claim due to worsening conditions is completed accurately and submitted timely.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in your worker information, including the claim number, name, home phone number, Social Security number, current home address, and mailing address if different.
3. Provide details regarding your claim history, including the date of the original injury and the date your claim was closed.
4. Describe your medical condition by listing the body parts affected, any symptoms, and when the condition worsened after the claim closure.
5. Indicate whether you have received any medical treatment since the claim closed and provide information on your treating doctor.
6. Answer questions about your employment status and any other injuries or illnesses you may have experienced since your claim closure.
7. Complete the section related to any benefits you are receiving or have applied for, along with details of your current or last employer.
8. Sign and date the form, permitting medical professionals to release your medical records associated with your claim.
9. Review all filled information to ensure accuracy, and then save, download, or print the completed form as required for submission.

Take charge of your claims process and complete your F242 079 000 Form online today.