Get Form 807

Filling out the Form 807 is an essential step for requesting coverage research services for pending workers' compensation claims. This guide provides clear, step-by-step instructions tailored to your needs, ensuring that you navigate the process smoothly.

Follow the steps to complete the Form 807 effectively

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the 'Pending Workers’ Compensation Claim Information' section with the details of the injured worker, including their name, date of injury, employer, WCAB number, insurer (if known), and claim number (if the request is made by a member insurer).
3. Complete the 'Requesting Party Information' section by providing the print name of the individual requesting information, their title or position, company name, telephone number, address, and email address for delivery of coverage information.
4. In the 'Coverage Information Requested' section, list both the physical address and, if applicable, the P.O. Box address of the employer(s) for which coverage is requested.
5. Certify your entitlement to receive the requested coverage information by checking the applicable boxes representing your status in relation to the workers' compensation claim.
6. Indicate the fees for the requested coverage by calculating the total amount based on the coverage year(s) and adding it to the designated section.
7. Select the appropriate payment method and, if applicable, provide the necessary authorization for member insurer billing.
8. After reviewing all filled sections for accuracy, save changes, download, print, or share the completed form according to your filing requirements.

Start your Form 807 request online today and ensure your coverage research needs are met.