Get Access To Worksafe Claim Information Request Form - Victorian ...

Filling out the Access To Worksafe Claim Information Request Form online can seem daunting, but this guide will help you navigate each step with ease. By following these instructions, you can ensure that you provide all necessary information to access your WorkSafe claim details.

Follow the steps to complete the form with confidence.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the 'TO' section, enter the name of your WorkSafe agent. This identifies who will receive your request for information.
3. Provide your details in the 'WORKER DETAILS' section. Include your family name, given names, title (Mr, Mrs, Ms, Dr, or specify), and signature, ensuring all information is accurate.
4. In the 'CLAIM DETAILS' field, input your claim number(s) and the name(s) of your employer(s) to ensure your request pertains to the correct claim.
5. Specify the documents you wish to receive in the 'INFORMATION REQUEST DETAILS' section by ticking the appropriate boxes, such as the worker’s claim form and medical certificates.
6. If you want to authorize a representative, complete the 'REPRESENTATIVE AUTHORITY' section by providing their name, contact address, and facsimile number, along with your signature.
7. If necessary, complete the 'NOMINATED HEALTH PRACTITIONER AUTHORITY' section if you want health documents to be sent directly to a designated practitioner.
8. Lastly, review the form for accuracy, sign in the 'PLEASE SIGN' section, and print your name if it is different from your signature.
9. After ensuring everything is completed correctly, save your changes, download, print, or share the form as needed.

Start filling out your Access To Worksafe Claim Information Request Form online today!