Board Rule 61(b)(25). Form WC-121. Change of TPA Claims Office/Servicing 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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