- Agreement For The Settlement Of An Award In A Lump Sum Or Partial Lump Sum {12A}
- Amputation Chart
- Amputation Chart Foot {7}
- Annual Payroll Report Operating As A Self Insurer{26C}
- Annual Report Of Premiums Assessments Etc Received By Insurance Carriers {26A}
- Annual Report Of Self Insurers Payroll By School Boards {26B}
- Annual Report Of Self Insurers Payroll {26}
- Annual Report Of Self-Insurers Payroll {26}
- Attending Physicians Report {6}
- Award Agreement {50}
- Change In Condition Claim Response
- Claim Form
- Claimants Affidavit
- COLA-Social Security Verification Request {CA51}
- Contractors Certification Of Workers Compensation Insurance {61A}
- Criminal Injuries Compensation Fund Claim Form
- Employer Report
- Employers Application For Hearing {5A}
- Employers Application For Individual Self Insurance {S120}
- Expedited Hearing Request
- Fatal Award Agreement {35}
- First Report Of Injury {3}
- Full And Final Mediation Request
- Full And Final Pre-Mediation Statement (All Claims)
- Full And Final Pre-Mediation Statement (Awarded Claim)
- Full And Final Pre-Mediation Statement (Contested Original Claim)
- Issue Mediation Request
- Letter For Beneficiary In Fatal Case
- Mediation And Mediators Evaluation Form
- Mediation Consent (With Legal Counsel)
- Mediation Consent (Without Legal Counse)
- Medical Care Provider Appication Response
- Medical Fee Schedule Dispute Request
- Medical Fee Schedule Dispute Response
- Medical Provider Inquiry
- Notice Of Cancellation Or Non Renewal {45H}
- Notice Of Change Cancellation Or Non-Renewal {45H-GSIA}
- Officer Manager Rejection Of Coverage {16A}
- Officer Manager Revocation Of Prior Rejection Of Coverage {17A}
- Parental Guarantee {22}
- PEO Parental Guarantee
- Petition For Medical Treatment
- Petition Under Birth Related Neurological Injury Compensation Act {BR1}
- Physicians Report On Injury In Lieu Of Testimony
- Pneumoconiosis Claim
- Referral For Lack Of Coverage
- Report Of Medical Cost {45-G}
- Report Of Minor Injuries {45-A}
- Request For Peer Review {50}
- Self Insurance Bond {21-A}
- Subpoena Duces Tecum Civil Attorney Issued
- Subpoena For Witness
- Subpoena For Witness Civil Attorney Issued
- Supplemental Agreement
- Supplemental Agreement To Pay Benefits {4A}
- Supplemental Agreement To Pay Varying Temporary Partial Benefits {4G}
- Supplementary Report {3A}
- Supplementary Report For Fatal Accidents {3B}
- Termination Of Wage Loss Award {CSD-133}
- Transportation Travel Expense
- Wage Chart {7A}
- Waiver Of Occupational Disease Coverage {9A}
- Webfile Access And PEO Registration
- Webfile Registration For Attorney Access
- Work Release
- Workers Compensation Notice {1}