- ABC Participation Agreement {1018-IE}
- AGC Participation Agreement {1018-IE}
- Agreement Of Assumption And Guaranty Of Workers Compensation {215E}
- Application For Dependents Benefits And Or Burial Benefits (Occupational Disease Claim) {027}
- Application For Dependents Benefits And Or Burial Benefits {025}
- Application For Hearing (Occupational Disease Claim) {026}
- Application For Hearing {001}
- Application For Hearing Failure Of Diligent Pursuit {502}
- Application For Hearing For Termination Or Reduction Of Compensation {402}
- Application For Hearing Medical Care Provider {024}
- Application For Hearing Noncooperation {602}
- Application For Lump Sum Or Advance Payment {134}
- Application For Self-Insurance {109}
- Application For Self-Insurance {223e}
- Application For Utah Workers Compensation And Utah Liability Insurance {1001-3}
- Application To Change Doctors {102}
- Appointment Of Counsel {152}
- Attending Physicians Statement {043}
- Authorization Request For Medical Treatment Carrier Response {223}
- Authorization To Disclose Release Use Protected Health Information (10 Years) HIPAA Compliant.{308}
- Authorization To Release Industrial Accident Division Records {205}
- Commutation Agreement
- Compromise Agreement
- Corporate Officer Exclusion From Workers Compensation Or Employers Liability Coverage {14-0061}
- Electronic Direct Deposit {WC-EDD}
- Emergency Medical Service Provider Exposure Report Form {350}
- Employee Notification Of Denial Of Claim {089}
- Employees Notification Of Intent To Leave State-Change Dr Or Hosp {044}
- Employers First Report Of Injury Or Illness {122E}
- Final Report Of Injury And Statement Of Total Losses {130}
- General Business Supplemental Questionnaire {1022}
- HBA Participation Agreement {1018-IE}
- Insurer-Employer Initital Reemployment Report For Injured Worker {206}
- Medical Treatment Provider List {307}
- Notice Of Alleged Workplace Saftey And-Or Health Violations
- Notice Of Filing Application For Hearing For Termination Or Reduction Of Compensation {404}
- Persons With Knowledge List {403}
- Petition For Reimbursement From The Employers Reinsurance Fund
- Request For Medical Records (Copies) {302}
- Request For Waiver Of Subrogation
- Request Or Appeal For Additional Medical Information {310}
- Request To Waive Or Postpone Reemployment Referral {215}
- Restorative Services Authorization Denial (Lower Extremity) {221c}
- Restorative Services Authorization Denial (Spine) {221a}
- Restorative Services Authorization Denial (Upper Extremity) {221b}
- Statement Of Benefits Paid {141}
- Statement Of Compensation {219}
- Statement Of Suspension Of Benefits {142}
- Subpoena
- Summary Of Medical Record Industrial Accident {113a}
- Summary Of Medical Record Occupational Exposure {113b}
- Trucking Questionnaire
- UMA Participation Agreement {1018-IE}
- URA Participation Agreement {1018-IE}
- URCA Participation Agreement {1018-IE}
- UTA Participation Agreement {1018-IE}
- Workers Compensation Notice