Workers Compensation Claim Form Templates
Workers Compensation Claim Forms are used to initiate a claim for workers' compensation benefits. These forms are typically used by employees who have suffered a work-related injury or illness and are seeking compensation for medical expenses, lost wages, and other related costs. The forms help gather necessary information about the employee, their injury, and the circumstances surrounding the incident to start the claims process.
Documents:
63
This Form is used for claimants to complete a questionnaire in the state of Maryland.
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This form is used by employers in Arizona to report any work-related injuries that occur on the job.
This form is used for documenting compensatory time earned by an employee for working additional hours beyond their regular schedule.
This Form is used for requesting an Independent Medical Exam in Louisiana.
This form is used for predesignating a personal physician in the state of California. It allows individuals to designate a specific doctor who will provide medical treatment if they are injured on the job.
This form is used to report occupational diseases in Connecticut, providing details about the patient's condition and its relation to their work environment.
This form is used for requesting the payment of compensation to an employee without a formal award.
This Form is used for filing a claim for compensation for a deceased civilian employee.
This form is used for reporting the first injury that occurred at the workplace in the state of Colorado.
This form is used for filing a workers' compensation claim and providing verification in the state of Alaska.
This Form is used for workers in Arizona to report an injury that occurred while on the job.
This Form is used for employers in Arizona to report industrial injuries suffered by their employees.
This form is used for petitioning a review of incapacity in the state of Maine.
This Form is used for reporting the first report of employee injury or illness for workers' compensation in the state of Indiana.
This form is used for making a claim request in Kentucky. It is specifically for the DEP6068 Sotra claim.
This Form is used for filing a motion to reopen a workers' compensation claim for benefits under Kentucky law (KRS 342.732).
This document is used to request a hearing for a final award in the state of Missouri related to workers' compensation.
This form is used for companies or organizations in Missouri to apply for authority to self-insure workers' compensation coverage.
This Form is used for filing a claim for compensation in a death case in New York for Chinese speakers.
This Form is used for filing a claim for compensation in a death case in New York. The form is available in Korean.
This form is used for employers and employees in Ohio who want to select a state other than Ohio as the exclusive remedy for workers' compensation claims.
This document is for filing an appeal with the Workers Compensation Appeal Tribunal in Prince Edward Island, Canada.
This document is used for submitting an Ancillary Medical Report in New York State. It is used to provide additional medical information related to a worker's compensation claim.
This form is used for reporting and resolving treatment or disputed bill issues in New York.
This form is used for requesting a rebate from the Oklahoma Workers' Compensation Multiple Injury Trust Fund.
This Form is used for making a claim for workers' compensation death benefits in the state of Texas.
This form is used for requesting an administrative review of a workers' compensation specialist's order in Tennessee.
This Form is used for providing workers' compensation information in Pennsylvania.
This form is used for controverting a medical claim in the state of Maryland.
This form is used for filing a workers' compensation claim in California. It is available in both English and Korean and helps injured workers seek benefits for work-related injuries.
This Form is used for applying for Independent Medical Review in California.
This form is used for reporting and filing injury or complaint of injury in the state of Indiana.
This form is used for requesting the closure of a workers' compensation claim in Colorado due to the failure to prosecute the case.
This Form is used for employees in Massachusetts to file a claim for their workplace injuries or illnesses.
This Form is used for notifying the primary liaison and adjusters involved in processing or supervising workers' compensation claims in Tennessee.
