Last updated: 2/16/2024
Worker Request For Reconsideration {2223a}
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Description
440-2223a - WORKERS' REQUEST FOR RECONSIDERATION. There can be only one reconsideration proceeding by the Workers’ Compensation Division (WCD) for any claim closure. All parties can raise issues and provide evidence within the statutory time limits. When permanent disability is raised, WCD will automatically review the compensable injury for temporary rating standards. Complete and send a signed copy of this form, along with any information you want reviewed, to: Appellate Review Unit, Workers’ Compensation Division. If you have an attorney, include a current signed retainer agreement. A beneficiary may use this form to request reconsideration. Please include name and contact information (including attorney, if any) with request. Attach additional sheets if needed. www.FormsWorkflow.com
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