Get Wa F242-079-000 2019-2026

The WA F242-079-000 form, also known as the application to reopen claim due to worsening of condition, is a crucial document for individuals seeking to revisit a closed claim due to a deterioration of their medical condition. This guide provides clear, step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to fill out the WA F242-079-000 form effectively.

1. Click the ‘Get Form’ button to access the WA F242-079-000 online form and open it in your preferred editor.
2. Begin by entering your claim number at the top of the form. This helps in identifying your previous case.
3. Fill out the 'Worker Information' section completely. Provide your full name, current home phone number, Social Security number for identification, and both your current home and mailing addresses.
4. Indicate whether your name has changed since your claim closed. If applicable, provide your previous name.
5. Specify the date of your original injury and when your claim was closed. Also, list your employer at the time of the original injury.
6. Document the name of your doctor who was treating you at the time your claim closed and outline the body parts that are affected by the injury or disease.
7. Indicate the date on which your condition worsened after the claim closure and describe your present physical complaints accurately.
8. Answer the questions regarding any new injuries or illnesses since your claim closure. If applicable, provide explanations.
9. Detail any medical treatment you have received since the claim closure including the names and addresses of your treating doctors.
10. Complete the employment section by answering whether you are currently working. If not, specify the reason along with your last date of employment.
11. Indicate whether you have applied for or are receiving any benefits such as unemployment or disability. Provide information on your last employer.
12. Ensure that the declaration statement is checked and sign the form. Don't forget to include the date of signing.
13. Once all sections are filled out thoroughly, save your changes. You may then download, print, or share the completed form as necessary.

Complete the WA F242-079-000 form online today to ensure your application for reopening your claim is processed efficiently.