Get Or 2839 2023-2026

The OR 2839 form is a crucial document for those requesting a hearing through the Workers’ Compensation Division. This guide aims to provide clear and comprehensive instructions on how to complete the form online, ensuring that users can efficiently navigate each section and accurately provide the required information.

Follow the steps to complete the OR 2839 form online.

1. Click the ‘Get Form’ button to access the OR 2839 form in the online editor.
2. Fill in the requester name and address fields. Make sure to provide accurate information as these details will identify you in the hearing process.
3. Enter the worker's name and address. This information is essential for linking the request to the correct case.
4. Provide contact details including the phone and fax numbers. Ensure that these are current and accessible.
5. If applicable, fill in the employer’s name and address, along with their contact details, particularly for Workers’ Benefit Fund assessment cases.
6. If the worker has an attorney, include their name and address as well as their phone number.
7. Specify the requester's identity by selecting the appropriate option from the provided list, indicating whether you are the worker, insurer, medical service provider, etc.
8. Indicate the date of injury in the relevant field.
9. Include the insurer claim number and WCD file number where indicated. This information helps to track your case efficiently.
10. State the order number being appealed, which must match the relevant administrative order.
11. In the section for requesting a hearing, check all applicable options that relate to your concern, such as medical fees or services.
12. Sign and date the form at the bottom to validate your request.
13. Once all fields are completed, you can save your changes, download, print, or share the OR 2839 form as needed.

Complete your documents online to expedite the hearing process.