Workers Compensation Forms and Templates

This form is used for filing a complaint against an employer in Arizona who does not have workers' compensation insurance coverage. It allows employees to report any injury or illness suffered at work and seek compensation for medical expenses and lost wages.

This Form is used for self-insured employers to complete an Agreement and Undertaking.

This form is used for reporting wage information in the state of Maine.

This form is used for California employers to report occupational injuries or illnesses suffered by their employees.

Ontario employers may use this form when they need to inform the authorities about the occupational illness or injury of one of their employees.

Este formulario se utiliza para presentar una moción en el estado de Ohio. Es un documento oficial en español.

This document is used for filing a petition in California to request the commutation of future payments for workers' compensation benefits.

This document is used for reporting chiropractic or acupuncture personal injuries in California.

This Form is used for designating a personal doctor in California. It is available in Spanish.

This Form is used for predesignating a personal physician in the state of California.

This Form is used for applying to join the Workers' Compensation Health Care Network in Texas. It is required for healthcare providers who wish to participate in the state's workers' compensation system.

This document is a worksheet used in Louisiana for calculating the loss cost multiplier for workers' compensation insurance.

This form is used for reporting self-insured injuries in the state of Arizona. It provides a way for individuals to document and report any injuries they have sustained while under a self-insured insurance plan.

This form is used for obtaining certification from a workers' compensation carrier in California. It ensures that the carrier has met the necessary requirements to provide coverage for workplace injuries and related expenses. This document is essential for employers to verify and maintain compliance with state regulations.

This form is used for reporting a supplemental report of a fatal injury in the state of Michigan.

This form is used for employers in Michigan to provide disclosure information.

This form is used for requesting a compliance hearing in the state of Michigan. It allows individuals to address any issues or disputes related to compliance with state laws or regulations.

This document is used for the carrier's response in Michigan workers' compensation cases.

This document is used for carriers and self-insured employers in Michigan to apply for an FTS user account.

This form is used for making voluntary payments in the state of Michigan.

This form is used for filing a notice of dispute in the state of Michigan. It allows individuals to formally notify the relevant authorities about a disagreement or conflict that needs to be resolved.

This form is used for notifying individuals in Michigan about their compensation payments. It provides information about the amount and frequency of the payments received.

This document is an opinion or order form used in the state of Michigan. It is used for legal purposes and may contain a judge's ruling or decision on a specific matter.