Requests authorization for additional therapy visits beyond the initial allowance.
- Completed by
- Physical, occupational or massage therapist
- Issued by
- Washington State Department of Labor & Industries (L&I)
- Format
- Language
- English
Washington F242-079-000: Application to Reopen Claim
Washington injured workers use this two-page application when an accepted condition has worsened and the claim has been closed for more than 60 days. The worker completes page one, and the treating provider documents current symptoms, measurable objective worsening since closure, work limitations, a treatment plan and ICD codes. L&I or the self-insurer decides on reopening, and the worker hears within 90 days of receipt.
Who completes it
The worker completes the worker page and gives it to the treating provider within 30 days of the medical services; the provider completes the provider page. To be the attending provider or certify restrictions, the provider must be in L&I's Medical Provider Network, though out-of-state providers are exempt.
Submitting and payment
- How to submit it
- Send it to the State Fund or Self-Insurance program address printed on the form so it is received within 60 days of any medical services made necessary by the worsening. Do not attach a bill.
- Who pays
- L&I pays the office call and diagnostic studies needed to complete the form under local code 1041M (one per request), while other unauthorized services are paid only if the claim reopens.
Good to know
- A claim can reopen only for objective worsening of the allowed condition since closure, not for an unrelated or preexisting condition or a new injury, which needs a new accident report.
- If the claim is reopened, benefits cannot be paid for services provided more than 60 days before L&I receives the form.
- The provider states what supported the comparison: being the provider at closure, reviewing the previous medical file, contacting the previous provider, or another source.
- L&I publishes a Spanish edition (F242-079-999), an English-Spanish bilingual edition and dozens of other translations of the application.
Get the official form
Download the current version from the source each time; forms change without notice.
Application to Reopen Claim Due to Worsening Condition
Fill it with Vero
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
How this list is checked
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Frequently asked questions
What is the deadline to file the Washington reopening application?
The completed application, with both worker and provider sections, must be received by the Department or self-insurer within 60 days of any medical services made necessary by the worsening. The worker should get their portion to the treating provider within 30 days of those services.
Will I be paid for completing the reopening application?
Yes, for the office call and the diagnostic studies needed to complete it, billed under local code 1041M. Payment for additional services that were not authorized depends on the reopening decision, and L&I notes payment may be delayed until that decision is made.
Is the reopening application required?
L&I's payment policy calls the form preferred but not required to start a reopening; the same information can be in chart notes, in which case it is bundled into the visit. Using the form keeps every question answered, and it warns that benefits may be delayed if it is incomplete.