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Get and Sign Audit Referral Form Audit Referral Form 2021-2022
Confidential, the Audit Unit
will not share your complaint with any party named in your complaint. If you do not
request confidentiality, the Audit Unit may share your complaint with the claims
administrator. Please note that your complaint and your workers’ compensation claim
information cannot be disclosed to the public under the Public Records Act. If you have
questions about this notice please write to Privacy@dir.ca.gov.
Claims administrator / Company name
Injured worker name
Claims...
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