Workers Compensation Forms and Templates

This form is used for entering into a lump sum rehabilitation agreement in the state of Nevada.

This form is used for electing a lump sum payment of compensation in the state of Nevada.

This form is used for authorizing workers' compensation claims in the state of New York. It allows individuals to give their consent for their employer to release relevant medical information for the purpose of processing their claim.

This Form is used for obtaining a Waiver Agreement under Section 32 of the New York Workers' Compensation Law in Bengali language. It is a document that allows parties to settle a workers' compensation claim.

This Form is used for Waiver Agreement related to Section 32 of the Workers' Compensation Law (WCL) in New York State. This specific form is in Yiddish language.

This document is used for filing a claim for compensation in a death case in New York with Yiddish translation.

This Form is used for doctors in New York to submit their initial report. It is a required document for reporting medical conditions and treatments.

This form is used in Ohio for physicians to certify proof of death. The form is known as Form C-44 (BWC-1163) Physician's Certificate in Proof of Death.

This Form is used for employees in Oklahoma to report their first notice of occupational disease and file a claim for compensation.

This Form is used for filing a claim related to workers' compensation discrimination or retaliation in the state of Oklahoma.

This document provides guidelines for employers in the state of Idaho. It covers various aspects of employer responsibilities, such as hiring, employee benefits, and workplace safety.

This form is used for employees and physicians in West Virginia to report occupational injuries or diseases.

This document is used for notifying a worker that their claim for workers' compensation has been denied in Washington, D.C.

This document is for applying for the Workers' Compensation Deductible Program in Wyoming. It allows employers to choose a deductible for their workers' compensation insurance.

This document is for requesting a certificate of coverage for workers' compensation and unemployment insurance in the state of Wyoming. It is necessary to demonstrate compliance with insurance requirements.

This document is a Spanish version of the C-42 (LB-0382) form used in Tennessee. It is an agreement between employer and employee regarding the choice of physician.

This Form is used for employers in Texas to report an employee's injury or illness to the Division of Workers' Compensation.

This form is used for reporting additional information about an injury in Texas workers' compensation cases.

This Form is used for settling benefit disputes in Texas workers' compensation cases.

This Form is used for reporting pharmacy services in the state of Texas.

This form is used for requesting a medical fee dispute resolution in Texas. It is for individuals who have a dispute with their medical provider or insurance company over the amount of a medical fee.

This Form is used for submitting a written request for an interlocutory order in the state of Texas. It is used to request a court order that addresses a specific issue during the course of a legal proceeding before a final judgment is made.

This form is used for notifying the Texas Division of Workers' Compensation about legal representation in a worker's compensation case.

This document is used for reporting workplace injuries to a supervisor in the state of Washington. It helps to keep a record of the incident and ensure proper follow-up and documentation.

This document is a guide provided by the Information & Assistance Unit in California for filing a workers' compensation claim. It provides step-by-step instructions on how to fill out the claim form, known as Form I&A1.

This document is a request form that is used in the state of Alabama to request a redetermination review of an NCCI (National Council on Compensation Insurance) ruling by Gainwell, a third-party administrator.

This document is used for providing proof of coverage in the state of Mississippi.

This Form is used for applying for a lump sum payment in the state of Mississippi.

This Form is used for medical report submission in Mississippi.

This form is used for filing a petition to controvert in the state of Mississippi. It is typically used in legal disputes related to workers' compensation claims.