DISPUTED CLAIM FOR MEDICAL TREATMENT Forms
| Form Name | DISPUTED CLAIM FOR MEDICAL TREATMENT |
| Form # | LWC-WC 1009 |
| Form Revision | Rev 12/2014 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Louisiana |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |