| Title |
Last Updated |
| Pro Se Settlement Order (For Unrepresented Claimant) |
August 18, 2011 |
| Final Payment Notice |
August 17, 2011 |
| Request To Erase (Redact) Medical Information From An Audio Recording |
August 4, 2011 |
| Notice and Proposal to Select an Independent Medical Examiner |
August 4, 2011 |
| Division IME Physician Summary Disclosure Form (Insurer Or Self-Insured Employer) |
August 1, 2011 |
| Division IME Physician Summary Disclosure Form (Claimant) |
August 1, 2011 |
| Designated Health Care Provider Disclosure Form |
August 1, 2011 |
| Temporary Partial Disability (TPD) Benefit Worksheet |
November 8, 2010 |
| First Report Transmittal |
November 8, 2010 |
| Notice Of Failed IME Negotiation |
November 8, 2010 |
| Request For Certification |
November 8, 2010 |
| Request for Offset of Liability to Subsequent Injury Fund |
November 8, 2010 |
| Dependents Notice and Claim for Compensation |
November 8, 2010 |
| Settlement Routing Sheet |
May 19, 2010 |
| Request For Expedited Hearing |
June 16, 2008 |
| Physicians Report Of Workers Compensation Injury With Instructions And Definitions |
March 23, 2007 |
| Petition To Review And Request For Transcript (Rule 26 OACRP) |
March 23, 2007 |
| Petition To Review (Rule 26 OACRP) |
March 23, 2007 |
| Petition For Review Of Findings Of Fact And Conclusions Of Law |
March 23, 2007 |
| IME Examiners Summary Sheet |
March 23, 2007 |
| Hearing Confirmation Rule 8(1) OACRP |
March 23, 2007 |
| Fatal Case-General Admission |
March 23, 2007 |
| Audio Recording Request |
March 23, 2007 |
| EDI Sender Acceptance Form |
March 14, 2007 |
| Order Approving Pro Se Settlement Agreement |
July 12, 2006 |
| Workers Claim For Compensation |
July 7, 2006 |
| Request For Appointment To The Independent Medical Examination Panel |
July 7, 2006 |
| Pharmacy Billing Statement |
July 7, 2006 |
| Employers First Report Of Injury |
July 7, 2006 |
| Customer Satisfaction Survey |
July 7, 2006 |
| Customer Satisfaction Survey (Mediation Services) |
July 7, 2006 |
| Application for Admission to the Colorado Major Medical Insurance Fund |
July 7, 2006 |
| Workers Claim For Compensation Transmittal |
May 19, 2006 |
| Settlement Checklist And Routing Sheet |
May 19, 2006 |
| Petition To Reopen |
May 19, 2006 |
| Senders Transmission Profile |
May 17, 2006 |
| Third Party Administrator Location List |
May 17, 2006 |
| Supplemental Report Of Return To Work |
May 17, 2006 |
| Trading Partner Insurer List |
May 17, 2006 |
| Request For State Hearing |
April 8, 2005 |
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