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  • Dis-enrollment Form - Lni Wa

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Center of Occupational Health & Education (COHE) Program Attending Provider in the Program (APP) Notice of Program Disenrollment Provider Name L&I Provider Number(s) Name of Clinic/Group,.

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About Labor and Industries (L&I) Overview.

Claim Reopenings. If your injury or occupational disease worsens, you and your doctor may apply to reopen your claim (F242-079-000). There must be objective medical evidence that after your claim has closed, the condition caused by the original workplace injury has worsened and needs more medical attention.

Average State of Washington L&I Workers' Compensation Adjudicator monthly pay in Washington State is approximately $4,050, which is 9% below the national average.

Industrial Injury Claims: You must file your industrial injury claim with L&I or your self-insured employer within one year of the date of the accident.

L&I maintains a list of self-insured employers. Your employer or their representative handles your paperwork and pays for the claim. They will give you a Self‑Insurer Accident Report (SIF‑2) form. Fill out the form completely and return it to your employer or their representative.

General information. Contact the Washington State Department of Labor & Industries for information about agency programs and services in your language at 1-800-547-8367. Once you are on the phone, please hold a moment while we call an interpreter to help us.

Online via our FileFast tool. By phone: 1-877-561-FILE (3453) At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232