Workers Compensation Forms and Templates

This form is used for agreeing on compensation for permanent partial disability in Ohio. It helps establish the amount of compensation that will be paid to an individual who has suffered a permanent partial disability.

This form is used for applying for compensation for permanent total disability in the state of Ohio.

This form is used for acknowledging and waiving the settlement in the case of a work-related death in Ohio. It signifies the final agreement between the parties involved.

This document is used for requesting a speaker or presentation from the Workers' Compensation Court Counselor Program in Oklahoma.

This form is used for self-insured employers in Idaho to report their semi-annual workers' compensation tax.

This form is used for reporting rehabilitation actions taken for an injured employee. It helps track the progress of the employee's rehabilitation process.

This type of document outlines the treatment plan for workers who have been injured on the job in Hawaii. It provides details of the medical treatments and services that will be provided to help the injured worker recover and return to work.

This Form is used for initiating legal proceedings to review orders issued by the Illinois Workers' Compensation Commission in relation to workers' compensation claims in Illinois.

This form is used for requesting a qualified medical evaluator panel for unrepresented employees in California.

This document is for unrepresented employees in California who are seeking a Qualified Medical Evaluator (QME) panel. It provides instructions on how to request the panel and guides the employee through the process.

This document is used for submitting a pre-trial conference statement in California workers' compensation cases.

This form is used for petitioning to change your primary treating physician in California's workers' compensation system.

This document is used for recording an employee's statement regarding an accident that occurred in Alabama. It helps to gather information about the incident for investigation purposes and potential insurance claims.

This form is used for employers in Alabama to report an employee's injury or occupational disease to the State Employees' Insurance Board.

This form is used for workers' compensation certification in the state of Kentucky. It is used to certify that an employer has workers' compensation coverage for their employees.

This document is used in Kansas to declare exemption from workers compensation under the Roofing Registration Act for roofing workers.

This type of letter states why a company is submitting a Workers Compensation Denial and how the worker can contest the findings if they so choose.

This Form is used for filing a claim for medical reimbursement from the Office of Workers' Compensation Programs (OWCP). It is used by individuals seeking compensation for their medical expenses related to a work-related injury or illness.

This Form is used for submitting claims for medical services provided to injured federal employees. It helps standardize billing and ensures proper reimbursement.

This form is used for filing a petition for settlement in Montana when there is an injury or occupational disease with reserved medical benefits.

This document is a form used in California for third party compromise and release. It is used to settle any disputes between the injured worker, employer, and the workers' compensation insurance carrier.

This document is a report used in California for workers' compensation cases filed with the Public Utilities Commission (PUC). It provides information on the compensation received by workers who were injured or became ill while performing their job duties for public utility companies.

This Form is used for reporting misclassification of workers in Rhode Island.

This form is used for employees in Connecticut who want to request the use of their accrued leave with workers' compensation.

This form is used for reporting workers' compensation payments made in New York City. It is an affidavit that requires information about the payments made to an injured worker.

This form is used for requesting mediation in Tennessee for injuries that occurred before July 1, 2014.