Application For Discretionary Payments From The Uninsured Employers Fund {DWC-UEF 50} | Pdf Fpdf Docx | California

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Application For Discretionary Payments From The Uninsured Employers Fund {DWC-UEF 50} | Pdf Fpdf Docx | California

Last updated: 6/8/2018

Application For Discretionary Payments From The Uninsured Employers Fund {DWC-UEF 50}

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Description

DWC-UEF 50, APPLICATION FOR DISCRETIONARY PAYMENTS FROM THE UNINSURED EMPLOYERS' FUND, applicant authorizes any doctors or hospitals that have treated me for this injury to furnish and disclose all facts concerning my medical condition that are within their knowledge, and to allow inspection of and provide copies of any records concerning my medical condition that are under their control. Rev: 11/2008. www.FormsWorkflow.com

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