Workers Compensation Forms and Templates

This form is used for requesting information from an insurer in the state of Colorado. It is used in cases where individuals or organizations need specific information from an insurance company.

This form is used for requesting utilization review in the state of Colorado. It is a request made by an individual or their representative to review the medical necessity and appropriateness of a recommended medical treatment or service.

This Form is used for requesting services in the state of Colorado.

This form is used for summarizing the examiner's division of IME (Independent Medical Examination) in Colorado.

This form is used for authorized treating providers in Colorado to request prior authorization for medical treatment.

This form is used by an authorized treating provider in the state of Colorado to notify the workers' compensation insurance carrier of a work-related injury or illness. It is used to report the details of the injury or illness and initiate the claims process.

This form is used for authorizing the release of information in the state of Colorado.

This Form is used for reporting the first injury in the state of Colorado.

This form is used for submitting a cover sheet for claims on appeal in Maryland. It is required to provide necessary information related to the action being taken on the appeal.

This form is used for Maryland residents who need to request a change of address for their workers' compensation claim.

This form is used for requesting a modification to a Maryland State Highway Administration project.

This form is used for submitting a controversion of medical claim in the state of Maryland. It is used to dispute the medical benefits requested by an injured employee.

This Form is used for amending a workers' compensation claim in Maryland.

This document is for individuals in Kentucky who are seeking an exemption from the Workers' Compensation Act. It is an affidavit that should be filled out to claim exemption.

This form is used for notifying the designated physician in the state of Kentucky. It is a mandatory requirement for certain legal proceedings or insurance claims.

This form is used for the entry of appearance in a legal matter in the state of Colorado. It is typically filed by an attorney to formally represent a party in court proceedings.

This form is used for workers in Colorado to file a claim for compensation for work-related injuries or illnesses.

This form is used for self-insurers in Kentucky to enter into a guarantee agreement.

This Form is used for dependent individuals in Colorado to notify and submit a claim for compensation in relation to a worker's injury or death.

This document is for disclosing the designated health care provider information in Colorado.

This Form is used for requesting a lump sum payment in the state of Colorado.

This form is used for requesting an offset of liability to the Subsequent Injury Fund in the state of Colorado.

This Form is used for submitting an answer to a claim for compensation in Missouri.

This form is used for disclosing the summary of the physician's evaluation to the claimant in a Colorado workers' compensation case.

This form is used for applying for self-insurance authorization in the state of Hawaii.

This form is used for submitting a response to an application for a hearing in the state of Hawaii. It is used to provide a written statement or answer to the original application.

This form is used for filing a petition in Maine to determine the average weekly wage for workers' compensation benefits.

This Form is used for filing a petition for compensation in case of a fatal work-related incident in the state of Maine.

This Form is used for filing a petition to request payment for medical and related services in the state of Maine.

This document is used in Maine to file a petition for an extension of benefits due to extreme financial hardship. It is based on the Maine Revised Statutes, Title 39-A, Section 213(1).

This form is used for employees in Maine to report their return to work after an injury or illness. It helps employers and the Workers' Compensation Board track the progress of the employee's recovery.

This form is used for applying for a waiver in the state of Maine.

This form is used for petitioning a review of incapacity in the state of Maine.

This form is used for an employee in Maine to petition for review of incapacity and request a provisional order related to workers' compensation.

This form is used for opting out of Workers' Compensation Coverage in Illinois.