- Application For 104 Weeks Dependents Benefits {OIC-WC-202}
- Application for Fatal Dependents Benefits {OIC-WC-201}
- Application For PTD Benefits {OIC-115}
- Application To Reopen Partial Disability Claim
- Attending Physician Benefits Form
- Carrier Request For Occupational Lung Center Examination
- Carrier-Self-Insured-TPA Request For Permanent Total Disability Review
- Controlled Substances Form
- Diagnosis Update
- Employees And Physicians Report of Occupational Hearing Loss {OIC-WC-1HL}
- Employees And Physicians Report Of Occupational Injury Or Disease {OIC-WC-1}
- Employees Report Of Occupational Pneumoconiosis {OIC-WC-1OP}
- Employers Report Of Occupational Injury Or Disease {OIC-WC-2}
- Employers Report Of Occupational Pneumoconiosis {OIC-WC-2OP}
- Failure To Timely Act (Petition Alleging Employer Or Its Claim Administrator)
- Low Back Examination
- Physicians Report Of Occupational Pneumoconiosis {OIC-WC-30P}
- Public Health Standards for Businesses Remaining Open During the COVID-19 Outbreak
- Request For Settlement Review {OIC-RSR1}
- Termination Of Coverage {OIC-E362}
- Workers Compensation Complaint Form