| Title | State |
Last Updated |
| Utilization Review Application (To Become An Approved Agent And Affidavit Of Compliance) |
Massachusetts | August 23, 2019 |
| Statement Of Eligibility To Serve On Roster Of Impartial Physicians |
Massachusetts | August 23, 2019 |
| Insurer Request Certification |
Massachusetts | August 23, 2019 |
| Affidavit (General Business) |
Massachusetts | August 23, 2019 |
| Utilization Review Agent Complaint Form |
Massachusetts | August 22, 2019 |
| Third Party Claim Notice Of Lien |
Massachusetts | August 22, 2019 |
| Request For Speedy Conference Because Of Hardship |
Massachusetts | August 22, 2019 |
| Request For Section 46a Conference With Lump Sum Under Section 48 |
Massachusetts | August 22, 2019 |
| Request For Section 37 Or 37A Proceeding |
Massachusetts | August 22, 2019 |
| Request For Lump Sum Conference |
Massachusetts | August 22, 2019 |
| Notification Of Arbitration Award |
Massachusetts | August 22, 2019 |
| Notice Of Change Appearance Of Counsel |
Massachusetts | August 22, 2019 |
| Motion For Expedited Conference |
Massachusetts | August 22, 2019 |
| Lien Disclosure Form |
Massachusetts | August 22, 2019 |
| Last Best Offer At Conference |
Massachusetts | August 22, 2019 |
| Insurers Notification Of Payment |
Massachusetts | August 22, 2019 |
| Insurers Hearing Memorandum |
Massachusetts | August 22, 2019 |
| Individual Written Rehabilitation Program |
Massachusetts | August 22, 2019 |
| Health Care Provider Complaint Form |
Massachusetts | August 22, 2019 |
| Employees Hearing Memorandum |
Massachusetts | August 22, 2019 |
| Employees Earning Report |
Massachusetts | August 22, 2019 |
| Employees Claim With Filing Instructions |
Massachusetts | August 22, 2019 |
| Employee Biographical Data |
Massachusetts | August 22, 2019 |
| Consent Of Employer To Lump Sum Settlement |
Massachusetts | August 22, 2019 |
| Complaint Of Improper Claims Handling Against Insurer |
Massachusetts | August 22, 2019 |
| Average Weekly Wage Computation Schedule |
Massachusetts | August 22, 2019 |
| Verification Of Massachusetts Workers Compensation Coverage For Out-Of-State Employers |
Massachusetts | August 22, 2019 |
| Conference Memorandum Cover Sheet |
Massachusetts | August 22, 2019 |
| Appeal Of Conference Proceeding |
Massachusetts | August 22, 2019 |
| Amendment-Suspension-Closure Of Vocational Rehabilitation Plan |
Massachusetts | August 22, 2019 |
| Agreement Under Section 37 Or 37A |
Massachusetts | August 22, 2019 |
| Agreement That No Impartial Physician Report Is Required |
Massachusetts | August 22, 2019 |
| Agreement For Redeeming Liability By Lump Sum - For Injuries Before 11-1-86 |
Massachusetts | August 22, 2019 |
| Affidavit Of Indigence And Request For Waiver Of Section 11A(2) Fees |
Massachusetts | August 22, 2019 |
| Affidavit Of Exemption For Certain Corporate Officers Or Directors |
Massachusetts | August 22, 2019 |
| Affidavit Of Employee In Application For Trust Fund Benefits |
Massachusetts | August 22, 2019 |
| Addendum To Lump Sum Settlement Agreement |
Massachusetts | August 22, 2019 |
| Affidavit In Support Of Employees Request For Speedy Conference Because Of Hardship |
Massachusetts | August 22, 2019 |
| Notice Of Commencement Termination Of Compensation |
Missouri | August 12, 2019 |
| Uniform Statewide Pretrial Stipulation |
Florida | July 31, 2019 |
| Application For Sheltered Workshop License (Labor Code Section 1191.5) |
California | July 31, 2019 |
| Request For Payment For Home Health Care |
North Dakota | July 30, 2019 |
| Request For Specific Findings Of Fact And Conclusions Of Law |
Colorado | July 30, 2019 |
| Hearing Confirmation |
Colorado | July 30, 2019 |
| Case Information Sheet (CIS) |
Colorado | July 30, 2019 |
| Application For Expedited Hearing |
Colorado | July 30, 2019 |
| Application For Expedited Hearing - One Time Change Of Authorized Treating Physician |
Colorado | July 30, 2019 |
| Application For Special Minimum Wage License (Labor Code Section 1191) |
California | July 30, 2019 |
| Application For Appointment Of Guardian Ad Litem |
North Carolina | July 29, 2019 |
| Notice Of Payment Or Suspension Of Benefits |
Georgia | July 18, 2019 |
