| Title | State |
Last Updated |
| Issues Form (Required With Forms H26R And H30R) |
Maryland | June 25, 2008 |
| Request For Document Correction |
Maryland | June 25, 2008 |
| Accident Prevention Plan Cover Sheet |
Texas | June 20, 2008 |
| Program Review Report w-Instructions |
Texas | June 20, 2008 |
| Medical Care Provider Application For Hearing |
Utah | June 18, 2008 |
| Summary Of Medical Record |
Utah | June 17, 2008 |
| Authorization To Disclose Release And Use Protected Health Information (Adjudication) |
Utah | June 17, 2008 |
| Authorization To Disclose Release And Use Protected Health Information (Industrial Accidents) |
Utah | June 17, 2008 |
| Medical Treatment Provider List (Adjudication) |
Utah | June 17, 2008 |
| Authorization To Release Labor Commission Records |
Utah | June 17, 2008 |
| Notice |
Kansas | June 13, 2008 |
| Notice To Dependents |
Connecticut | June 2, 2008 |
| Form Notice To Compensation Commissioner And Employee Of Intention To Discontinue Or Reduce Payment |
Connecticut | June 2, 2008 |
| Medical Treatment Provider List (Industrial Accidents) |
Utah | May 30, 2008 |
| Claim Amendment |
Maryland | April 9, 2008 |
| Application For Division Approval Of Purchase Of Annuity For Lifetime Income Benefits |
Texas | April 3, 2008 |
| Employer Request For DWC Safety Consultation |
Texas | April 3, 2008 |
| Application For Division Approval Of Change In Payment Period And Or Purchase Of Annuity For Death Benefits |
Texas | April 3, 2008 |
| Claimants Request For Further Action |
New York | April 2, 2008 |
| Rehabilitation Request |
Connecticut | April 1, 2008 |
| Hearing Request |
Connecticut | April 1, 2008 |
| Carriers Or Employers Request For Further Action |
New York | March 12, 2008 |
| Return-To-Work Pilot Program For Small Employers |
Texas | February 28, 2008 |
| Stipulated Rehabilitation Plan |
Maryland | February 20, 2008 |
| Initial Rehabilitation Services Referral Form |
Maryland | February 15, 2008 |
| Workers Compensation Claimants Questionnaire (Uninsured Employer) |
Maryland | February 15, 2008 |
| Information Report |
Maryland | February 15, 2008 |
| Controversion Of Medical Claim |
Maryland | February 15, 2008 |
| Insurers Reconciliation Statement 2007 |
Vermont | February 15, 2008 |
| Assessment Report 2007 |
Alabama | February 7, 2008 |
| Notice Of Withdrawal Of Exempt Employers Voluntary Election |
Tennessee | January 25, 2008 |
| Notice Of Corporate Officer To Employer Of Election Not To Accept Provisions Of Workers Compensation Act Of Tennessee |
Tennessee | January 25, 2008 |
| Notice Of Withdrawal Of Sole Proprietor Or Partner Election |
Tennessee | January 25, 2008 |
| Utilization Review Notification |
Tennessee | January 25, 2008 |
| Notice Of Withdrawal From Coverage Of The Tennessee Workers Compensation Law |
Tennessee | January 25, 2008 |
| Utilization Review Closure |
Tennessee | January 25, 2008 |
| Notice Of Lawsuit |
Tennessee | January 25, 2008 |
| Notice Of Denial Of Claim For Compensation |
Tennessee | January 25, 2008 |
| Notice Of First Payment Of Compensation |
Tennessee | January 25, 2008 |
| Notice Of Acceptance Of Workers Compensation Act Of Tennessee By Exempted Employer |
Tennessee | January 24, 2008 |
| Final Report Of Payment And Receipt Of Compensation |
Tennessee | January 24, 2008 |
| Election Of Sole Proprietor Or Partner To Come Within The Provisions Of The Tennessee Workers Compensation Law |
Tennessee | January 24, 2008 |
| Case Management Closure |
Tennessee | January 24, 2008 |
| Attending Physicians Report |
Tennessee | January 24, 2008 |
| Employers First Report Of Work Injury Or Illness |
Tennessee | January 24, 2008 |
| Home Builders Association Questionaire |
Utah | December 28, 2007 |
| Explanation Of Benefits |
Texas | December 28, 2007 |
| Application For Utah Statutory Employee Exlcusion Policy |
Utah | December 21, 2007 |
| Request For Setting And Notice Of Hearing |
New Mexico | December 21, 2007 |
| Truckers Supplemental Application |
Indiana | December 18, 2007 |
