Michelle Miranda 503-947-7841
you submit your request for hearing using the online form an e-mail
is sent to the Workers' Compensation Division that contains the information
you enter in the form. After you click "submit" you will receive
a confirmation page that can be printed, copied, and mailed to the other
Not all information will apply to every case.
Complete all areas that apply.
Required fields *
attorney (if any) name and address:
Managed care organization
Medical service provider
request a hearing concerning (check all that apply):
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