Ons not issued pursuant to D.C. Code 1-623.23(a2)(4), 1-623.24(b) or 1-623.24(d) by the District of Columbia Public Sector Workers Compensation Program (PSWCP). READ INSTRUCTIONS HERE AND ON THE REVERSE SIDE For Help and Information, call (202) 727-8600 APPEAL DEADLINE: Your request must be received by the Office of Risk Management (ORM) within fifteen (15) calendar days, from the date that the PSWCP issued the decision. If the calendar-day filing deadline falls on a Saturday, Sunday, o.
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How to fill out the DC PSWCP Form 9-A online
Filing an appeal using the DC PSWCP Form 9-A is a crucial step for individuals looking to challenge decisions made by the District of Columbia Public Sector Workers’ Compensation Program. This guide provides clear, step-by-step instructions on how to fill out the form online, ensuring that your appeal is submitted accurately and efficiently.
Follow the steps to complete your DC PSWCP Form 9-A online.
- Click the ‘Get Form’ button to access the DC PSWCP Form 9-A and open it in your preferred online editor.
- Begin by entering the claimant's name in the designated field. Ensure that the name matches the individual's identification.
- In the next field, provide the full address of the claimant, including unit number and zip code.
- If applicable, fill in the representative's information. Include their full name and address.
- Enter the claimant's telephone number and email address in the respective fields.
- Input the claim number as specified in your correspondence with the Public Sector Workers’ Compensation Program.
- Record the date of the decision that you are appealing. This is crucial for establishing the appeal deadline.
- Select the nature of your appeal by checking the appropriate box. Be specific about the area you are contesting.
- Clearly articulate your reasons for disagreeing with the program decision. Answer all required questions, providing detailed facts and what you wish the Chief Risk Officer to do.
- Count the total number of pages that will accompany your appeal, including attachments, and record this in the relevant field.
- Sign and date the form, affirming that all information is true to the best of your knowledge.
- Finally, save your completed form and consider downloading or printing it for your records, ensuring that you maintain a copy for future reference.
Ensure your appeal is heard by completing the DC PSWCP Form 9-A online today.
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