Workers Compensation Forms and Templates

This document is used for an employee in Tennessee to choose their physician. It is available in English and Spanish.

This Form is used for filing a workers' compensation claim in California, and is available in both English and Chinese language.

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 document is a declaration form used in California labor cases. It is specific to Labor Code Section 4906(H) and is used for a specific purpose related to labor law.

This form is used for petitioning the California Division of Workers' Compensation for the commutation of future payments.

This Form is used for applying for Independent Medical Review in California.

This document is used for notifying patients about their appointment with a Qualified Medical Evaluator (QME) in California.

This document is used for requesting a factual correction of an unrepresented panel QME report in California.

This Form is used for applying for discretionary payments from the Uninsured Employers' Fund in California.

This form is used for reporting the first injury that occurred in Virginia. It must be completed and submitted to the Virginia Workers' Compensation Commission.

This form is used for ordering workers' compensation publications in Kansas.

This form is used for documenting the final admission details of a fatal case in Colorado.

This form is used for notifying and negotiating for workers' compensation benefits in the state of Colorado. It is related to the process of settling disputes regarding compensation for work-related injuries or illnesses.

This Form is used for disclosing the summary report of the Independent Medical Examination (IME) conducted by the Division Independent Medical Examination (DIME) physician to the insurer or self-insured employer.

This form is used for reporting the first injury occurring at the workplace in Connecticut.

This form is used for reporting supplemental information about an employee's return to work in the state of Colorado. It provides details about the employee's job duties, work hours, and any restrictions or accommodations.

This Form is used for resolving disputes and finalizing agreements between parties involved in a legal case in Colorado. It helps to document the terms of the settlement reached and serves as an official court order.

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 applying for a Preliminary Hearing in Kansas. It is necessary for individuals involved in a legal case to request a preliminary hearing in order to have their case reviewed by a judge before going to trial.

This form is used for Russian-speaking employees in New York to submit a claim for compensation.

This Form is used for Polish employees in New York to file a claim for workplace injury or illness.

This form is used for Chinese employees in New York to file a claim for various employment-related matters.

This document is used for employees in New York to file a claim related to their employment. It specifically caters to employees who are Italian.

This form is used for employees in New York who need to file a claim. The form is available in Korean language.

This document is used for calculating the loss cost multiplier for insurance companies, excluding workers' compensation. It helps determine the pricing and premiums for various insurance policies.

This document is used for calculating the Company Loss Cost Multiplier for Workers' Compensation insurance.

This type of document is used for reporting negotiated deductibles in workers' compensation insurance in Texas.

This form is used to provide employees in South Carolina with a notice outlining the terms of their employment.

This Form is used for posting notice about workers' compensation insurance in Pennsylvania.

This form is used for an employee to voluntarily waive their rights to workers' compensation benefits in Missouri.

This Form is used for requesting total temporary compensation in Ohio.

This document is a supplemental tax report used in Oklahoma for reporting workers' compensation awards.

This form is used for reporting the assessment for the Workers' Compensation Multiple Injury Trust Fund (MITF) in Oklahoma during the specified assessment period.