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Form F242-423-000 Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance - Washington
What Is Form F242-423-000?
This is a legal form that was released by the Washington State Department of Labor and Industries - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form F242-423-000?
A: Form F242-423-000 is a Declaration of Entitlement for Totally DisabledWorker Benefits under Industrial Insurance in Washington.
Q: What is the purpose of this form?
A: The purpose of this form is to declare the entitlement for totally disabled worker benefits.
Q: Who is eligible for totally disabled worker benefits?
A: Workers who are totally disabled and unable to work due to an industrial injury or occupational disease are eligible for these benefits.
Q: What information is required on this form?
A: The form requires information about the worker's personal details, injury or disease, medical treatment, and employment history.
Q: Are there any deadlines for submitting this form?
A: Yes, there are deadlines for submitting this form. It is important to submit the form within one year from the date of injury or knowledge of the occupational disease.
Q: What happens after submitting this form?
A: After submitting this form, the Department of Labor & Industries will review the information provided and make a determination on the worker's entitlement to benefits.
Q: What if my claim is denied? Can I appeal?
A: If your claim is denied, you have the right to appeal the decision. You can request an appeal and provide additional supporting evidence.
Q: Are there any other forms or documents I need to submit?
A: Depending on the circumstances, additional forms or documents may be required. It is best to consult with the Department of Labor & Industries for specific requirements.
Q: Can I receive other benefits while receiving totally disabled worker benefits?
A: It is possible to receive other benefits, such as Social Security Disability benefits, while receiving totally disabled worker benefits. However, there may be coordination of benefits rules.
Q: How long will it take to receive benefits?
A: The processing time for benefits can vary. It is recommended to contact the Department of Labor & Industries for an estimated timeline.
Q: Is there a fee for submitting this form?
A: No, there is no fee for submitting this form.
Form Details:
- Released on November 1, 2019;
- The latest edition provided by the Washington State Department of Labor and Industries;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form F242-423-000 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.
