Free Maine Workers Compensation Forms

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56 Forms found in Maine — Workers Compensation — Page 1 of 2
Title Last Updated
Employees Return To Work Report April 5, 2016
Petition To Determine Entitlement To Rehabilitation Services April 4, 2016
Request For Independent Medical Examination March 17, 2016
Request For Expedited Proceeding March 17, 2016
Release Of Unemployment Information March 17, 2016
Providers Petition For Payment Of Medical And Related Services March 17, 2016
Petition To Remedy Discrimination March 17, 2016
Petition To Determine Extent Of Permanent Impairment March 17, 2016
Petition To Determine Average Weekly Wage March 17, 2016
Petition For Review Of Incapacity March 17, 2016
Petition For Review Of Extended Benefits Awarded Due To Extreme Financial Hardship March 17, 2016
Petition For Restoration March 17, 2016
Petition For Reinstatement March 17, 2016
Petition For Payment Of Medical And Related Services March 17, 2016
Petition For Extension Of Benefits Due To Extreme Financial Hardship March 17, 2016
Petition For Award Of Compensation March 17, 2016
Petition For Award Of Compensation - Occupational Disease Law March 17, 2016
Petition For Award Of Compensation - Fatal March 17, 2016
Notice Of Intent To Appeal March 17, 2016
Motion For Award Of Fees And Disbursements March 17, 2016
Fringe Benefits Worksheet March 17, 2016
Employment Status Report March 17, 2016
Employees Return To Work Report March 17, 2016
Employee Petition For Review Of Incapacity And Request For Provisional Order March 17, 2016
Employee Expense Form March 17, 2016
Discontinuance Or Modification Of Compensation March 17, 2016
Consent Between Employer And Employee March 17, 2016
Application For Evaluation Employment Rehabilitation Services March 17, 2016
Wage Statement March 11, 2016
Statement Of Compensation Paid March 11, 2016
Schedule Of Dependents And Filing Status Statement March 11, 2016
Practitioners Report March 11, 2016
Memorandum Of Payment March 11, 2016
Lump Sum Settlement March 11, 2016
Limited Certificate Authorizing Written Release Of Medical Or Health Care Information March 11, 2016
Certificate Of Discontinuance Or Reduction Of Compensation March 11, 2016
Certificate Authorizing Release Of Benefit Information August 18, 2015
Application For Predetermination Of Independent Contractor Status (Rebuttable Conclusive Presumption) August 18, 2015
Complaint For Penalties March 15, 2013
Application For Wage Credit Rehabilitation Fund March 15, 2013
Petition For Forfeiture February 14, 2013
Notice Of Controversy February 14, 2013
Employers First Report Of Occupational Injury Or Disease February 14, 2013
Complaint For Audit February 14, 2013
Application For Waiver February 14, 2013
Application For Predetermination Of Independent Contractor Status To Establish Conclusive Presumption February 14, 2013
Application For A Certificate Of Independent Status February 14, 2013
Complaint For Audit October 11, 2012
Application For Predeterm Construction Subcontractor Establish A Rebuttable Presumption December 1, 2010
Notice Of Workers Compensation Insurance May 15, 2006