Ing workers' compensation claim. Before the coverage request will be processed, the requesting party must certify that he/she is entitled to receive the information, that the information will be used solely in connection with the pending workers' compensation claim, and that the information will not be otherwise published, distributed, or released to third parties other than in connection with the administration and/or litigation of the pending workers' compensation claim. Employers or insurers.
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How to fill out the Form 807 online
Filling out the Form 807 is a straightforward process that enables users to request coverage research related to pending workers' compensation claims. This guide will walk you through each section of the form to ensure your application is complete and accurate.
Follow the steps to successfully complete Form 807
- Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Begin by providing the necessary pending workers’ compensation claim details. This includes the name of the injured worker, date of injury, insurer information (if known), claim number, and WCAB number (if assigned). Ensure all fields are filled as incomplete entries can delay processing.
- Next, fill in the requesting party information, including the name of the individual making the request, their title or position, the company they represent (if applicable), their contact number, and complete address. If the requester is an attorney, indicate the party they represent.
- Under the certification section, select the appropriate box that describes your role in relation to the pending claim. This ensures that the WCIRB verifies your entitlement to receive the requested information.
- Specify the coverage information you are requesting by providing details of the employer, their address, and the coverage year(s) needed. If additional employers require coverage information, attach a separate sheet.
- Sign and date the form to certify that the provided information is true and correct, and check the box if you prefer to receive the information via email.
- Finally, include your payment information, as the WCIRB accepts payment by check only. Make sure to send this along with the completed form to the specified address.
Complete your documents online to ensure timely processing and accurate information.
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