Get 10770 5 Verification

Filling out the 10770 5 Verification form online can seem daunting, but this guide will help you navigate each section with ease. By following these steps, you will ensure that your lien claim is filed accurately and effectively.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the appropriate reason for filing the lien claim. You can choose from the following options: the time since the date of acceptance or rejection of liability has passed, or the timeframe for payment of medical treatment or medical-legal expenses has elapsed. Ensure you check the box that aligns with your situation.
3. Next, you must declare under penalty of perjury that one of the specified time periods has elapsed. You will also need to confirm that if an application for adjudication is being filed, the venue is correct and that no adjudication case number exists for the same injured worker and date of injury.
4. You must detail the diligent search you conducted to confirm that no adjudication case number exists. In the designated space, provide a clear description of your efforts to ensure accuracy in your filing.
5. Finally, sign your name in the signature section provided and add the date in the format MM/DD/YYYY. Review the completed form for any errors before proceeding.
6. Once all fields are correctly filled out, save your changes. You can then download the completed form, print it, or share it as needed.

Start filling out your 10770 5 Verification online now to ensure your lien claim is processed.