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Washington State Department of Labor & Industries (L&I) fax number

(360) 902-6690

Self-Insurance Section

Used for: Filing claims related to workplace injuries: ROA for L&I-insured patients and Providers Initial Report (PIR) for self-insured employers; fax to 360-902-6690 or 1-800-941-2976, or file online.

Fax destination details

Department
Self-Insurance Section
Purpose
Filing claims related to workplace injuries: ROA for L&I-insured patients and Providers Initial Report (PIR) for self-insured employers; fax to 360-902-6690 or 1-800-941-2976, or file online.
Form
ROA (Report of Industrial Injury or Occupational Disease) / PIR (Providers Initial Report) — ROA (Report of Industrial Injury or Occupational Disease) and PIR (Providers Initial Report)
Address
PO Box 44291, Olympia, WA 98504-4291
Voice phone
360-902-6901

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Submit ROA via online filing or fax (2-day deadline to fax to 1-800-941-2976 or 360-902-6690). If the patient is self-insured, submit PIR (F207-028-000).

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