Workers Compensation Forms and Templates

This Form is used to request authorization or for a carrier or self-insured employer to respond to a request.

This Form is used for requesting an Independent Medical Exam in Louisiana.

This form is used for recording the minutes of a hearing at the Workers' Compensation Appeals Board (WCAB) in California. It documents the proceedings, arguments, and decisions made during the hearing.

This form is used to request a panel of qualified medical evaluators in California for medical evaluations related to workers' compensation claims. It helps injured workers select a medical evaluator for their case.

This form is used for requesting a stop payment for workers' compensation benefits in Louisiana.

This form is used for predesignating a personal physician in the state of California. It allows individuals to designate a specific doctor who will provide medical treatment if they are injured on the job.

This form is used to report occupational diseases in Connecticut, providing details about the patient's condition and its relation to their work environment.

This form is used for submitting a Notice of Possible Claim against the Second Injury Fund in Alaska. It provides a way for individuals to inform the state about potential claims related to workplace injuries.

This form is used for reporting workers' compensation cost-of-living adjustment (COLA) data in Massachusetts.

This document is used for requesting reimbursement for travel costs in Texas.

This form is used for submitting workers' compensation fees in New Mexico.

This document is used to report a worker's compensation injury in the state of Delaware. It is completed by a physician to provide detailed information about the injury and the worker's condition.

This form is used for transferring compensation experience in Texas. It is a questionnaire that helps in evaluating and recording compensation data.

This Form is used for submitting a supplementary report in Alabama workers' compensation cases. It is required to provide additional information or updates related to a worker's injury or claim.

This Form is used for employers in Georgia to provide notice of their intent to contest a workers' compensation claim.

This Form is used for notifying individuals in California about work pay details. It may provide information regarding wages, benefits, or other compensation.

This form is used for reporting the physical capacities of an individual in the state of California.

This Form is used for providing evidence to support a claim for occupational disease.

This Form is used for cancelling the election made by an employee who owns 10 percent or more of the corporate stock of their employer to not accept coverage under the Kansas Workers Compensation Act.

This form is used for requesting the payment of compensation to an employee without a formal award.

This document is used for OTC Form WC-2 Insurance Premium Assessment in the state of Oklahoma.

This form is used for reporting the tax on workers' compensation awards in Oklahoma.

This document is used for reporting workers' compensation awards for tax purposes in Oklahoma.

This form is used for filing a claim for compensation by parents, brothers, sisters, grandparents, or grandchildren. It is a document that allows these family members to seek compensation in cases of injury or death of a federal employee.

This Form is used for submitting a Notice of Appeal to the Workers' Compensation Court of Appeals in Minnesota. It is the first step in the process of challenging a decision related to workers' compensation benefits.

This form is used for reporting the assessment made by the Multiple Injury Trust Fund (MITF) to Group Self-Insurance Associations in Oklahoma for workers' compensation claims.

This document is used for reporting the assessment for the Oklahoma Workers' Compensation Multiple Injury Trust Fund. It is specifically for individual self-insured employers.

This form is used for reporting assessments to the Workers' Compensation Multiple Injury Trust Fund (MITF) in Oklahoma.

This form is used for the election of employer for volunteer workers in Kansas.

This form is used to file an election by an employer of public service workers in Kansas.

This form is used for understanding the rights and responsibilities related to workers' compensation in Kansas. It is available in both English and Spanish.

This Form is used for employees in Kansas to elect not to accept coverage for certain benefits.

This Form is used for employers in Kansas to elect coverage for their employees. It allows employers to choose whether or not to provide workers' compensation insurance.

This Form is used for reporting the medical treatment and status of injured workers in Florida's Workers' Compensation system. It helps to track the progress of the injured worker's medical treatment and determine their eligibility for benefits.