Get Instructions For Request For Offset To Liability To Sif.qxd - Colorado ...

Filling out the Instructions For Request For Offset To Liability To SIF.qxd is a crucial step in managing your liability requests in Colorado. This guide provides a clear and supportive overview to help you complete the form online accurately.

Follow the steps to successfully complete your request form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. In the 'Claimant' field, click to enter your information. Navigate through the fields using the tab key to proceed without issues.
3. Fill in the 'W.C. #', 'Employer', 'Social Security #', 'Carrier Claim #', and 'Insurance Carrier' fields, ensuring to use numbers only for the Social Security field without any dashes.
4. In the section that requires you to indicate if an offset is claimed, choose either section A for prior industrial disability or section B for covered occupational diseases and complete the relevant fields accordingly.
5. For section A, list prior workers’ compensation cases by entering the employer's name, W.C. number, description of injuries, and award amount for each case in the provided fields.
6. For section B, indicate the type(s) of exposure by filling in the type of exposure, approximate date of exposure, and the employer’s name and address. Use additional sheets if necessary.
7. Once all fields are completed, review your information for accuracy. If changes are required in individual fields, use the backspace or delete key.
8. To clear any errors or start fresh, click on the red 'Clear Entire Form' button at any time.
9. After completing the form, you can print it for submission, ensuring that a copy of the request and all relevant documents are sent to the Director of the Division of Workers’ Compensation.

Begin your process of completing the necessary forms online today.