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Board Rule 61b25 Form Wc121 Change Of Tpa Claims Officeservicing Agent

An insurer, self-insurer, or self-insurance fund shall file this form to give:

(1)  notice of the employment of a claims office;

(2)  change an address of a claims office;

(3)  add additional claims offices; and

(4)  notice of the termination of services of a claims office.

  • Form WC-121. Change of TPA Claims Office/Servicing Agent

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