Workers Compensation Forms and Templates

This type of document is an agreement used in Delaware to outline compensation for death.

This form is used for designating records for review of a decision made by the Workers' Compensation Commission or the Workers' Compensation Court of Existing Claims in Oklahoma.

This document is a checklist that helps the Workers' Compensation Coordinator in Minnesota manage and process claims for agency workers.

This document contains information and privacy statement related to the Workers' Compensation Program in Minnesota. It outlines the program's policies and procedures regarding the collection and use of personal information.

This form is used for applying to reopen a claim in Washington state due to a worsening of a medical condition. The form is available in both English and Japanese languages.

This form is used for applying to reopen a claim in the state of Washington if the condition has worsened. It is available in both English and Kurdish languages.

This document is for filing a claim for death benefits in Maryland on behalf of a dependent.

This form is used for applying for a Worker's Compensation Prehearing and Hearing Appearance Permit in Wisconsin.

This form is used for notifying an employee in Texas about the intention to request division permission to adjust their benefits.

This form is used for applying for certification as a designated doctor in the state of Texas.

This Form is used for applying for a Certificate of Approval to conduct workers' compensation self-insurance group (SIG) business in the state of Texas.

This form is used for terminating a Workers' Compensation Self-insurance Group (SIG) Certificate of Approval in Texas. It provides a checklist of items that need to be completed for the termination process.

This form is used for obtaining a surety bond by a Workers' Compensation Self-insurance Group (SIG) Administrator or Service Company in Texas. The bond ensures financial protection for injured workers in case of any default or non-compliance by the SIG Administrator or Service Company.

This form is used for employers in Texas who want to become members of a Workers' Compensation Self-Insurance Group (SIG).

This form is used for making changes to the corporate governance documents checklist of a Workers' Compensation Self-insurance Group (SIG) in Texas.

This form is used for reporting any changes in performance or fidelity bond for Workers' Compensation Self-insurance Group (SIG) in Texas.

This form is used for acknowledging the indemnity agreement for group self-insurance coverage of Workers' Compensation Insurance in Texas.

This Form is used for notifying the Texas Workers' Compensation Self-insurance Group (SIG) about workers' compensation self-insurance.

This document is a checklist for the contract requirements of a Workers' Compensation Network Contract with an insurance carrier in Texas. It ensures all necessary elements are included in the contract.

This form is used for reviewing the contract checklist for managing health care networks in Workers' Compensation cases in Texas.

This document is used for reporting instances of workers' compensation fraud in Oklahoma.

This document is used to appeal a decision by the Workers' Compensation Board in New York to the Appellate Division, Third Department. It notifies the court that the decision is being appealed.