Informal hearing workers 2025

1. Click ‘Get Form’ to open the application for informal hearing in the editor.
2. Begin by entering your Social Security Number, ensuring it is exactly 9 digits. This is crucial for identification purposes.
3. Fill in your personal details including your name, phone number, address, birth date, city, zip code, and county. Make sure all information is accurate and clearly printed or typed.
4. Next, provide your employer's name and address along with the insurance company’s details. If unsure about the insurance company’s name, refer to your employer or contact the Compensation Rating and Inspection Bureau.
5. Indicate the date of the accident and type of injury sustained. This information is essential for processing your claim.
6. Complete the eligibility questions regarding Medicaid benefits at the time of the accident. Your responses will help determine any necessary repayments.
7. Finally, sign and date the form at the bottom to validate your application before submission.

Start filling out your informal hearing workers application today for free using our platform!