You’re offline. This is a read only version of the page.
Official Government Website
Toggle navigation
Home
Forms
Forms
EXT Request
Public Records Request
Sign in
Public Records Request
1
Requester Type
2
Requester Information
3
Claim(s) Information
4
Review and Submit
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
Clear lookup field
Launch lookup modal
Lookup records
×
Close
We're sorry, an error has occurred.
There are no records to display.
You don't have permissions to view these records.
Error completing request.
Loading...
Error
×
Close
We're sorry, an error has occurred.
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.
Leave this field blank
