| Title |
Last Updated |
| Attending Physicians Report |
July 18, 2019 |
| Amputation Chart |
May 10, 2019 |
| Claim For Benefits |
May 10, 2019 |
| Annual Payroll Report Operating As A Self Insurer{26C} |
December 26, 2018 |
| Petition Under Birth Related Neurological Injury Compensation Act |
December 26, 2018 |
| Expedited Hearing Request |
December 26, 2018 |
| Annual Report Of Self Insurers Payroll By School Boards |
December 26, 2018 |
| Fatal Award Agreement |
December 26, 2018 |
| Employers Application For Hearing |
December 26, 2018 |
| Contractors Certification Of Workers Compensation Insurance |
December 26, 2018 |
| Annual Report Of Premiums Assessments Etc Received By Insurance Carriers |
December 26, 2018 |
| Agreement To Pay Benefits |
December 26, 2018 |
| Wage Chart |
December 26, 2018 |
| Subpoena For Witness Civil Attorney Issued |
December 26, 2018 |
| Subpoena For The Taking Of Deposition |
December 26, 2018 |
| Subpoena Duces Tecum |
December 26, 2018 |
| Subpoena Duces Tecum Requesting Party |
December 26, 2018 |
| Subpoena Duces Tecum Civil Attorney Issued |
December 26, 2018 |
| Request For Mediation |
December 26, 2018 |
| Parental Guarantee |
December 26, 2018 |
| Officer Manager Rejection Of Coverage |
December 26, 2018 |
| Irrevocable Letter Of Credit |
December 26, 2018 |
| Termination Of Wage Loss Award |
November 8, 2018 |
| COLA-Social Security Verification Request |
June 14, 2018 |
| Officer Manager Rejection Of Coverage |
December 30, 2012 |
| Employer Report |
August 13, 2012 |
| Claimants Affidavit |
July 10, 2008 |
| Supplemental Agreement To Pay Varying Temporary Partial Benefits |
July 10, 2008 |
| Supplemental Agreement To Pay Benefits |
July 10, 2008 |
| Report Of Medical Cost |
July 10, 2008 |
| Report Of Minor Injuries |
July 10, 2008 |
| Employers Accident Report |
July 10, 2008 |
| Supplementary Report For Fatal Accidents |
May 25, 2007 |
| Amputation Chart Foot |
May 23, 2007 |
| Self Insurance Bond |
April 6, 2007 |
| Waiver Of Occupational Disease Coverage |
April 6, 2007 |
| Workers Compensation Notice |
December 5, 2006 |
| Letter To Sheriff |
October 23, 2006 |
| Subpoena For Witness |
July 13, 2006 |
| Notice Of Change Cancellation Or Non-Renewal |
May 25, 2006 |
| Confidential Informational Letter For Employee Not Represented By Counsel |
May 25, 2006 |
| Confidential Informational Letter For Employee Not Represented By Counsel And Settlement Contains Blanket Release |
May 25, 2006 |
| Agreement To Pay Benefits In A Fatal Case |
March 10, 2006 |
| Annual Report Of Self-Insurers Payroll |
March 10, 2006 |
| Criminal Injuries Compensation Fund Claim Form |
September 13, 2005 |
| Notice Of Cancellation Or Non Renewal |
September 13, 2005 |
| Agreement For The Settlement Of An Award In A Lump Sum Or Partial Lump Sum |
February 8, 2005 |
| Contractors Certification Of Insuring Liability |
February 8, 2005 |
| Disability Statement |
February 8, 2005 |
| Employers Application For Individual Self Insurance |
February 8, 2005 |
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