Workers Compensation Forms and Templates

This document is for New York employees who need to file a claim and it is available in Haitian Creole.

This Form is used for employees in New York to file a claim for certain benefits. It provides instructions on how to properly fill out and submit Form C-3.

This Form is used for attending doctors in New York to request authorization and for insurance companies to respond to their requests.

This Form is used for renewing the approval of a workers' compensation self-insurance program in Rhode Island.

This Form is used to apply for initial workers' compensation exemption registration in Tennessee.

This document is used for making a statement regarding a claim for worker's compensation benefits in Utah.

This document is used for reporting the progress of a patient's treatment by their primary treating physician in the state of California.

This type of document, called the DIA WCAB Form 2 (DIA2), is used in California for applying for the adjudication of a claim related to a death case.

This document is used for recording additional minutes of a hearing in the state of California.

This document is used for declaring readiness to proceed to an expedited hearing (trial) in the state of California for a workers' compensation case.

This form is used for filing a Declaration of Readiness to Proceed in a workers' compensation case in California.

This Form is used for reporting the outcome of a lien conference in a workers' compensation case in California.

This form is used for filing a workers' compensation claim in California. It is available in both English and Spanish.

This form is used for primary treating physicians in California to report on the permanent and stationary status of the injured worker.

This form is used for reporting the permanent and stationary status of the primary treating physician in California workers' compensation cases.

This form is used for filing a petition to reopen a workers' compensation case in the state of California.

This form is used for requesting a summary rating determination of the primary treating physician report in California. It helps with evaluating the rating for work-related injuries and determining the appropriate benefits for the injured worker.

This form is used for requesting a consultative rating in the state of California.

This type of document is used for reporting work-related incidents and injuries in the state of Georgia, United States. It is specific to workers' compensation cases.

This Form is used for electing workers' compensation leave in the state of Georgia, United States.

This document is a Workers' Compensation Transitional Employment Plan specific to the state of Georgia in the United States. It outlines a plan to help injured workers return to work on a temporary basis while they recover from their injuries.

This form is used for controverting a medical claim in the state of Maryland.

This form is used for requesting a correction of a document in the state of Maryland.

This document is a request to appoint a Nevada attorney to represent injured workers in legal matters.

This form is used in New Jersey to convert a voluntary tender to a formal judgment in a dependency claim petition.

This Form is used for appointing an authorized representative for a claimant in the state of Ohio.