Workers Compensation Forms and Templates

This document is used for summarizing the findings of a Qualified Medical Evaluator in unrepresented injured employee cases in California.

This document is used for seasonal workers in Arkansas to complete an affidavit.

This Form is used for employers in Ontario, Canada to report injuries and diseases that occur in the workplace. It is a legal requirement for employers to complete and submit this form to the appropriate government agencies.

This form is used for releasing medical records related to workers' compensation claims in the state of New York.

This form is used for requesting a mandatory alternate duty or modified duty work assignment in the state of New York. It allows employees to seek accommodations for their job duties due to medical or other reasons.

This form is used for reaching a compromise settlement agreement between an employer and an employee in Oklahoma regarding the facts related to an injury and the payment of compensation.

This Form is used for filing an occupational disease claim in the state of Utah. It is the official form required for workers who have contracted a disease as a result of their job.

This form is used for requesting a hearing in Utah to terminate or reduce compensation.

This document provides a checklist for employers in Ohio to ensure compliance with compensation regulations and best practices. It includes information on wage and hour laws, employee benefits, and payroll procedures.

This document is for reporting finger amputation impairment in South Dakota. It is used to provide relevant information about the amputation to the Department of Labor in order to assess disability benefits.

This document is for collecting information related to a workers compensation claim in the state of Oklahoma.

This form is used for quarterly reporting of workers' compensation experience in Oklahoma. It is specifically designed for employers with mega deductibles.

This form is used for employers in Rhode Island who are authorized to directly pay workers' compensation benefits to their employees or their dependents.

This Form is used for requesting mediation in workers' compensation cases in South Dakota.

This document is used for paying the filing fees for workers' compensation policies in South Dakota.

This form is used for reporting the first injury in South Dakota.

This form is used for applying for a hearing to file an industrial accident claim in Utah. It provides instructions on how to proceed with your claim.

This Form is used for applying for a hearing in Utah regarding an occupational disease claim.

This Form is used for an Agreement of Assumption and Guaranty of Workers' Compensation in the state of Utah. It outlines the responsibilities and obligations of parties involved in assuming and guaranteeing workers' compensation liabilities.

This Form is used for reporting the initial reemployment of an injured worker by an insurer or employer in Utah.

This Form is used for reporting the first injury or illness that occurred in the state of Utah.

This Form is used for employees in Utah to request reimbursement from the Employers' Reinsurance Fund.

This form is used for notifying the state of Texas about the election to self-insure for workers' compensation.

This form is used for political subdivisions in Texas to certify their self-insurance for workers' compensation, general liability, and/or motor vehicle liability insurance.

This Form is used for businesses in Texas to notify the authorities of their election to self-insure for workers' compensation coverage.

This document is used for certifying a political subdivision's self-insurance for workers' compensation, general liability, and/or motor vehicle liability insurance in Texas.

This form is used for employers in Rhode Island who are authorized to directly pay workers' compensation benefits to their employees or their dependents.

This form is used for notifying the state of Rhode Island about a claim for a compensable injury. It is an important document for workers seeking workers' compensation benefits in Rhode Island.