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Public Records Request
1
Requester Type
2
Requester Information
3
Claim(s) Information
4
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Requester Type
Request Type
*
NOTE
: Requests for workers’ compensation records on claims closed
prior
to January 1, 2004, will require a separate submission of form
RMR-6
.
Authorized party other than claimant (e.g. attorneys, claims adjusters)
Employer (post-offer claims history)
Claimant (personal claims records)
Submitted By Contact Id
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Employer A.D.A. Status
Americans with Disabilities Act (A.D.A.) Status
Employer subject to provisions of A.D.A.
Employer exempt from provisions of A.D.A.
