Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance Forms
| Form Name | Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance |
| Form # | F242-423-000 |
| Form Revision | 11-2019 |
| Category | Forms » Disability |
| Downloads | |
| Form State | Washington |
| Language | English |
| State Description | n/a |
| Claimwire Description | n/a |