Get Form 807

Filling out the Form 807, the Coverage Research Service Request, is a crucial step for people seeking coverage information related to pending workers' compensation claims. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the Coverage Research Service Request Form.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing information about the pending workers' compensation claim. Fill out the section labeled 'Pending Workers’ Compensation Claim Information' where you will enter details such as the injured worker's name, date of injury, claim number, and the WCAB number if assigned.
3. Next, complete the 'Requesting Party Information' section. Here, enter the name of the individual requesting information, their title or position, the company name or the injured worker they represent, and the contact details including phone number and email address.
4. In the 'Certification' section, check off the applicable options that define your relationship to the claim. Ensure that you affirm the statement regarding your authority to request the coverage information and provide a signature along with the date.
5. Provide the 'Coverage Information Requested' by entering the names and addresses of the employers for whom you seek coverage information. If you have multiple employers, include them on a separate sheet as necessary.
6. Lastly, review all entered information to ensure it is complete and accurate. You must send the form by mail, as a signature is required. If you wish to receive information by email, check the designated box on the form.
7. Prepare your payment, which must be made by check only, and include it with your request when mailing the form to the WCIRB.

Complete your Coverage Research Service Request Form online today for a smooth and efficient filing experience.