Get Or 2839 2012

The OR 2839 form is a critical document for requesting a hearing regarding workers' compensation claims. This guide will provide step-by-step instructions for filling out the form online, ensuring you understand each section and field to facilitate a smooth filing process.

Follow the steps to confidently complete the OR 2839 form online.

1. Press the ‘Get Form’ button to obtain the OR 2839 form and open it in your preferred editor.
2. Begin by entering the requester's name and address in the designated fields. Ensure that this information is accurate as it will identify who is making the request.
3. Next, fill in the worker's name and address below the requester information. This is essential for properly identifying the individual involved in the workers' compensation case.
4. Provide your contact phone number and optional fax number in the respective fields for any follow-up communication.
5. If this request is related to a Workers' Benefit Fund assessment, enter the employer’s name and address, along with their phone and fax details.
6. If there is a worker's attorney involved in the case, include their name and address, as well as a contact phone number.
7. Specify the identity of the requester by selecting the appropriate option from the provided choices—worker, insurer, medical service provider, etc.
8. Indicate the date of injury in the given field, as this is a crucial piece of information for the request.
9. Input the insurer claim number and the WCD file number if applicable, as well as the order number that is being appealed.
10. Mark all applicable issues concerning the hearing request by checking the appropriate boxes related to medical fee disputes, medical services, vocational assistance, penalties, and other relevant concerns.
11. Sign the form in the designated area to validate your request for the hearing.
12. Choose how you would like to submit your completed form. You may mail it to the specified address, deliver it in person, send it by fax, email it, or utilize the online submission options if available.
13. Finally, after submitting the form, keep a copy for your records and be sure to verify that all intended parties receive a copy of the request.

Complete your documents online confidently and ensure your request for hearing is processed efficiently.