REQUEST FOR LUMP SUM PAYMENT (Permanent Partial, Permanent Total and Dependents’ Benefits) Forms
| Form Name | REQUEST FOR LUMP SUM PAYMENT (Permanent Partial, Permanent Total and Dependents’ Benefits) |
| Form # | WC62 |
| Form Revision | Rev. 07/14 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | Page 1 of this form is used by the claimant to request that permanent disability benefits be paid in a lump sum. Page 2 of the form is used by the insurer to provide proof to the Division of accurate |
| Claimwire Description | n/a |