DHA Admission to Service and Answer to Application

Document Number: WKC-19-DHA-E

Description: This DHA form is to be filed by the respondent insurer or employer in response to an Application for Hearing. The answer should be filed with the department and copied to the party who filed the application.

Comments: This form is an electronic Microsoft Word template that can be filled out on your computer (if you have Microsoft Word). If you do not have Microsoft Word we are providing a PDF (WKC-19-DHA) which you can print and complete by hand.

Content Contact: Lynn Weinberger

Document Attachments:

WKC-19-DHA-E (Electronic Version - Word/76 KB)

WKC-19-DHA (Print Version - pdf/36 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.