Authorization For File Review Or Release Of Copies Of Claim File {FE0005} | Pdf Fpdf Doc Docx | Minnesota

 Minnesota   Workers Comp 
Authorization For File Review Or Release Of Copies Of Claim File {FE0005} | Pdf Fpdf Doc Docx | Minnesota

Last updated: 10/1/2025

Authorization For File Review Or Release Of Copies Of Claim File {FE0005}

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Description

MN FE0005 - AUTHORIZATION FOR FILE REVIEW OR RELEASE OF COPIES OF WORKERS' COMPENSATION CLAIM FILE. This Minnesota Department of Labor and Industry form allows a designated person or organization to review and/or receive copies of a DLI workers’ compensation claim file for the employee and specific date(s) of injury listed. By signing, an authorized party (e.g., employee; parent/guardian; employer; insurer; dependent of a deceased employee; estate representative; or Special Compensation Fund representative) permits DLI to release nonpublic file data, including the worker identification (WID) number or SSN. A copy is as valid as the original, and the authorization is effective for six months or until withdrawn. Instructions cite Minn. Stat. § 176.231, subd. 9 and Minn. R. 5220.2880 www.FormsWorkflow.com

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