Self-Insured (SI) Permanent Total Disability and Fatality Data Report Forms
| Form Name | Self-Insured (SI) Permanent Total Disability and Fatality Data Report |
| Form # | WC167 |
| Form Revision | Rev 12/18 |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |