| Title |
Last Updated |
| Elective Surgery Notification |
May 30, 2019 |
| Report Of Injury Or Illness |
May 30, 2019 |
| Request For Reconsideration (Spanish) |
May 28, 2019 |
| Worker Leasing Notice Client Proof Of Coverage |
November 20, 2018 |
| Termination Of Workers Compensation Coverage |
November 20, 2018 |
| Client Update Info Notice |
November 20, 2018 |
| Application For Worker Leasing Company License |
November 20, 2018 |
| Insurers Report |
November 20, 2018 |
| Employer At Injury Program Reimbursement Request |
November 20, 2018 |
| Tax Compliance Certification (Attachment C) |
July 17, 2018 |
| Indemnity Agreement By Parent Corporation For Wholly-Majority Owned Subsidary |
July 17, 2018 |
| Endorsement To Include Legal Entity In Self-Insured Certification |
July 17, 2018 |
| Request To Change Attending Physician Or Authorized Nurse Practitioner |
July 17, 2018 |
| Request For Hearing |
July 17, 2018 |
| Insurers Request For Director Approval Of Insurer Medical Examination |
July 17, 2018 |
| Physician Assistants Statement Of Certification |
July 17, 2018 |
| Service Companys Notification Of Business |
July 17, 2018 |
| Insurers Notification Of Business In Oregon |
July 17, 2018 |
| Tax Compliance Certification (Attachment A} |
July 6, 2018 |
| Worker Request For Reconsideration |
December 29, 2016 |
| Application For Self Insurance |
December 28, 2016 |
| Request For Workers Compensation Division Claim File Information |
December 28, 2016 |
| Medical Fee Dispute Resolution Request And Worksheet |
December 28, 2016 |
| Insurer Request For Reconsideration |
December 28, 2016 |
| Preferred Worker Job Offer Letter |
April 13, 2015 |
| Vocational Closure Report |
April 13, 2015 |
| Response To Issues |
April 13, 2015 |
| Vocational Assistance Certification Program Authorization Of Vocational Assistance Provider |
April 13, 2015 |
| Vocational Assistance Certification Program Individual Certification Under OAR 436-120 |
April 13, 2015 |
| Visual Impairment |
April 13, 2015 |
| Workers Benefit Fund Assessment Corrections And Changes Notification |
April 13, 2015 |
| Claim Disposition Agreement |
April 13, 2015 |
| Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan |
October 1, 2014 |
| Workers Compensation Payroll And Assessment Quarterly Report Retrospective Rating Plan (5-12) |
October 1, 2014 |
| Workers Compensation Payroll And Assessment Quarterly Report Normal Plan |
October 1, 2014 |
| Workers Compensation Payroll And Assessment Quarterly Report Normal Plan (5-12) |
October 1, 2014 |
| Self Insurer Report Of Losses Non Experience Rating Period |
October 1, 2014 |
| Self Insurer Report Of Losses Experience Rating Period |
October 1, 2014 |
| Group Self Insured Indemnity Agreement |
October 1, 2014 |
| Exemption Provision Waiver |
October 1, 2014 |
| Endorsement To Self Insured Group Application |
October 1, 2014 |
| Claims Reserved In Excess Of Self-Insured Retention |
October 1, 2014 |
| Preferred Worker Program Quarterly Claim Cost Reimbursement Request |
October 1, 2014 |
| Notice Of Intent To Form A Managed Care Organization |
October 1, 2014 |
| Request Ror Reimbursement Of Expenses |
October 1, 2014 |
| Medical Billing Data EDI Trading Partner Profile |
October 1, 2014 |
| IME Observer Form |
October 1, 2014 |
| Subpoena To Compel Production of Individually Indentifiable Health Information |
October 1, 2014 |
| Subpoena To Compel Production |
October 1, 2014 |
| Request For Board Review |
October 1, 2014 |
