Get Gov Request For Workers Compensation Records Mail: Division Of Workers Compensation 401 Sw Topeka

This guide provides a detailed, step-by-step approach to completing the Gov REQUEST FOR WORKERS COMPENSATION RECORDS form. Following these instructions will ensure you accurately submit your request for workers compensation records online, facilitating efficient processing.

Follow the steps to successfully complete your request for workers compensation records.

1. Press the ‘Get Form’ button to access the request form, which will open in your document editor.
2. Begin filling out the form by providing your name in the 'Requestor name' section, followed by your phone number. This is essential for the Division to contact you if there are questions regarding your request.
3. In the 'Company or Entity' area, specify the name of your organization or entity if applicable, along with your fax number for correspondence.
4. Complete the 'Address' section with your street address, city, state, and ZIP code to ensure the Division can reach you or send your records.
5. Next, enter the name of the worker whose records you are requesting, followed by their Social Security number (SSN). Ensure that the SSN is accurate to avoid delays.
6. Indicate the records you seek by checking the appropriate options for accident report summaries, docket summaries, actual filings, or requesting electronic downloads.
7. Based on the appropriate category, identify whether you are the employer, insurance carrier, or representative related to the worker. Fill out the relevant details and date of the accident.
8. If applicable, specify if you are an employer offering conditional employment to the individual. Include the type of job conditionally offered.
9. The worker must sign the release authorization, allowing the Division to release the specified records. Include the date of the signature.
10. Both the requestor and worker must provide their signatures along with the respective dates to confirm the information is true and correct.
11. Review all entered information for accuracy, making necessary corrections before finalizing the document.
12. Once completed, save your changes. You can then download, print, or share your form as needed.

You are now ready to complete your request for workers compensation records online. Follow the steps outlined above to ensure a smooth submission process.