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Insurer Telephone Number To Get Oregon Claims Processing Location Information 4865 - Oregon

Insurer Telephone Number To Get Oregon Claims Processing Location Information Form. This is a Oregon form and can be used in Insurer And Self Insurer Workers Comp .
 Fillable pdf Last Modified 4/14/2010
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Insurer telephone number to get Oregon claims processing location information Workers' Compensation Division Note: The telephone number will be posted on the Workers' Compensation Division (WCD) employer coverage Web site. Information to be published on the Web: Insurer: ( Telephone number to get processing location information (mandatory): Web-based claims location look-up (optional): ) - Claims processing location mailing address for insurers with a single Oregon processing location (optional): Address: City: State: ZIP+4 - Contact for questions or issues on above information: Please provide the name of a person or department within your company we can contact for any questions or issues that come up about the above information you have provided. WCD will not publish the following contact information on our external Web site. Contact name: Address: City: Title: State: ZIP+4 - ( Phone: E-mail address: ) Fax: ( ) - This information was submitted by: Contact name: Address: City: State: ZIP+4 American LegalNet, Inc. www.FormsWorkFlow.com Title: ( Phone: E-mail address: Mail this form to: ) Fax: ( ) - Workers' Compensation Division Attn: Insurer Registration P.O. Box 14480 Salem, OR 97309-0405 or fax it to: 503-934-6048 440-4865 (9/09/DCBS/WCD/WEB) c:\program files\serena\collage\docconv\transactions\1254351138480_180\upload\21897_58901.doc 2 American LegalNet, Inc. www.FormsWorkFlow.com
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