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983 Forms found in Workers Compensation — Page 1 of 20
TitleState Last Updated
Renewal Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers New YorkJuly 28, 2015
Initial Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers New YorkJuly 28, 2015
Doctors Initial Report New YorkJuly 28, 2015
ADR Program Final Disposition Of Claim New YorkJuly 28, 2015
Report Of Work-Related Injury Or Occupational Disease New YorkJuly 28, 2015
Disagreement With Proposed Vocational Rehabilitation Plan MarylandJuly 23, 2015
Authorization For Release Of Medical Information MarylandJuly 9, 2015
Employee Claim New YorkJuly 7, 2015
Beneficiary Claim For Death Benefits TexasJune 26, 2015
Employer Notice Of No Coverage Or Termination Of Coverage TexasJune 26, 2015
Initial Application By Employee Of Licensee Under Section 50 3-b Or 50 3-d To Appear Before WCB New YorkMay 4, 2015
Stockholder Of Corporation Applying For License To Represent Self-Insurers New YorkMay 4, 2015
Voluntary Agreement ConnecticutApril 17, 2015
Subpoena Or Subpoena Duces Tecum Or Subpeona Duces Tecum For Medical Record MarylandApril 13, 2015
Statement Of Wage Information MarylandApril 13, 2015
Settlement Worksheet MarylandApril 13, 2015
Request For Transcript MarylandApril 13, 2015
Request For Emergency Hearing MarylandApril 13, 2015
Insurer Request For Change Of Address MarylandApril 13, 2015
Health Providers Request For Decision On Unpaid Medical Bills New YorkMarch 26, 2015
Petition for Benefit Determination TennesseeFebruary 27, 2015
Claim For Medical Services MarylandFebruary 4, 2015
Claim For Medical Services MarylandFebruary 4, 2015
Report Of Medical Evaluation TexasJanuary 23, 2015
Power Of Attorney TexasJanuary 23, 2015
Employers Application For Permission To Carry Risk Without Insurance (For New And Renewal Applicants) IndianaJanuary 21, 2015
Employees Request To Change Treating Doctors (Non Network) (Spanish) TexasJanuary 15, 2015
Request For Reimbursement Of Payment Made By Health Care Insurer TexasJanuary 15, 2015
Surety Bond IndianaJanuary 13, 2015
Indemnity Agreement By Parent Corporation For Wholly Owned Or Majority Owned Subsidiary IndianaJanuary 13, 2015
Proposed Vocational Rehabilitation Plan MarylandJanuary 13, 2015
Request To Implead A Party MarylandJanuary 13, 2015
Cover Sheet For Action On Claims On Appeal MarylandJanuary 13, 2015
Controversion Of Medical Claim MarylandJanuary 13, 2015
Claimants Consent To Pay Attorney And Doctor Fees MarylandJanuary 13, 2015
Agreement On The Propriety Of Services And Selection Of Practitioner MarylandJanuary 12, 2015
Notice Of Treatment Issue(s)-Disputed Bill Issue(s) New YorkDecember 23, 2014
Continuation To Form MG-2 Attending Doctors Request For Approval Of Variance New YorkDecember 23, 2014
Continuation To Form MG-1 Attending Doctors Request For Optional Prior Approval New YorkDecember 23, 2014
Attending Doctors Request For Optional Prior Approval And Carriers-Employers Response New YorkDecember 23, 2014
Attending Doctors Request For Authorization And Carriers Response New YorkDecember 23, 2014
Attending Doctors Request For Approval Of Variance And Carriers Response New YorkDecember 23, 2014
Inspection Form ConnecticutDecember 23, 2014
Employer Participation Form ConnecticutDecember 23, 2014
Education Services Order Form ConnecticutDecember 23, 2014
Utilization Review Company Minimum Standards ConnecticutDecember 23, 2014
Employees Multiple Employment Wage Statement (Spanish) TexasNovember 18, 2014
Request To Enter Appearance Of Counsel MarylandNovember 13, 2014
Request To Enter Appearance Of Counsel MarylandOctober 14, 2014
Report Of Temporary Total Disability IndianaOctober 14, 2014