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2,275 Forms found in Workers Comp — Page 1 of 46
TitleState Last Updated
Verification Form CaliforniaOctober 2, 2014
Verification (Petition To Reopen) CaliforniaOctober 2, 2014
Verification (Petition For Benefits For Serious And Willful Misconduct Of Employer) CaliforniaOctober 2, 2014
Verification (Commutation Of Future Payments) CaliforniaOctober 2, 2014
Pre-Trial Conference Statement CaliforniaOctober 2, 2014
Verification (Application For Discrimination Benefits Pursuant To Labor Code Section 132a) CaliforniaOctober 1, 2014
Application (Petition) For Discrimination Benefits Pursuant To Labor Code Section 132a CaliforniaOctober 1, 2014
Application (Petition) For Benefits For Serious And Willful Misconduct Of Employer CaliforniaOctober 1, 2014
Annual Report Of Inventory For Claims Reported During Calendar Year CaliforniaOctober 1, 2014
Termination Of Workers Compensation Coverage To Client Of Worker Leasing Company OregonOctober 1, 2014
Vocational Closure Report OregonOctober 1, 2014
Vocational Assistance Certification Program Individual Certification Under OAR 436-120 OregonOctober 1, 2014
Vocational Assistance Certification Program Authorization Of Vocational Assistance Provider OregonOctober 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan OregonOctober 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan (5-12) OregonOctober 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Normal Plan OregonOctober 1, 2014
Workers Compensation Payroll And Assessment Quarterly Report Normal Plan (5-12) OregonOctober 1, 2014
Self Insurer Report Of Losses Non Experience Rating Period OregonOctober 1, 2014
Self Insurer Report Of Losses Experience Rating Period OregonOctober 1, 2014
Indemnity Agreement By Parent Corporation For Wholly-Majority Owned Subsidary OregonOctober 1, 2014
Group Self Insured Indemnity Agreement OregonOctober 1, 2014
Exemption Provision Waiver OregonOctober 1, 2014
Endorsement To Self Insured Group Application OregonOctober 1, 2014
Claims Reserved In Excess Of Self-Insured Retention OregonOctober 1, 2014
Request For Workers Compensation Division Claim File Information OregonOctober 1, 2014
Request To Change Attending Physician Or Authorized Nurse Practitioner OregonOctober 1, 2014
Request For Hearing OregonOctober 1, 2014
Preferred Worker Program Quarterly Claim Cost Reimbursement Request OregonOctober 1, 2014
Preferred Worker Job Offer Letter OregonOctober 1, 2014
Visual Impairment OregonOctober 1, 2014
Physician Assistants Statement Of Certification OregonOctober 1, 2014
Notice Of Intent To Form A Managed Care Organization OregonOctober 1, 2014
Elective Surgery Notification OregonOctober 1, 2014
Request Ror Reimbursement Of Expenses OregonOctober 1, 2014
Medical Billing Data EDI Trading Partner Profile OregonOctober 1, 2014
Insurers Notification Of Business In Oregon OregonOctober 1, 2014
IME Observer Form OregonOctober 1, 2014
Subpoena To Compel Production of Individually Indentifiable Health Information OregonOctober 1, 2014
Subpoena To Compel Production OregonOctober 1, 2014
Response To Issues OregonOctober 1, 2014
Request For Board Review OregonOctober 1, 2014
Cost Bill Form OregonOctober 1, 2014
Employer-At-Injury Program (EAIP) Reimbursement Request Form OregonOctober 1, 2014
Workers Benefit Fund Assessment Corrections And Changes Notification OregonOctober 1, 2014
Application To Become A Self Insured Employer Group-Private Employers OregonOctober 1, 2014
Application To Become A Self Insured Employer Group-Governmental Subdivisions OregonSeptember 30, 2014
Application For Self Insurance OregonSeptember 30, 2014
Application For Worker Leasing Company License OregonSeptember 30, 2014
Request For Hearing And Specification Of Issues OregonSeptember 30, 2014
Claim Disposition Agreement OregonSeptember 30, 2014