| Title | State |
Last Updated |
| Workers Report Of Injury |
Arizona | February 3, 2014 |
| Carriers Explanation Of Benefits |
Michigan | January 31, 2014 |
| Application For Mediation Or Hearing-Form B |
Michigan | January 23, 2014 |
| Rehabilitation Election |
Ohio | January 20, 2014 |
| Plan Of Action |
Ohio | January 20, 2014 |
| Lump Sum Settlement (LSS) Direct Reimbursement Payment and Rating Program For Public Employer State Agencies |
Ohio | January 17, 2014 |
| Labor Lease Transaction Payroll |
Ohio | January 17, 2014 |
| Handicap Reimbursement Election |
Ohio | January 17, 2014 |
| Self-Insured Employers Initial Report Of Accident Prevention Program |
Pennsylvania | January 14, 2014 |
| Group Self-Insurance Fund Member Annual Contribution Worksheet Form |
Pennsylvania | January 14, 2014 |
| Initial Report Of Accident And Illness Prevention Program Status |
Pennsylvania | January 14, 2014 |
| Expense Loss Cost Multiplier Worksheet For Group Sel-Insurance Fund |
Pennsylvania | January 14, 2014 |
| Expense Loss Cost Multiplier Worksheet For Group Sel-Insurance Fund |
Pennsylvania | January 14, 2014 |
| Electronic Data Interchange First Report Of Injury |
Pennsylvania | January 13, 2014 |
| Annual Report Of Accident And Illness Prevention Program Status |
Pennsylvania | January 13, 2014 |
| Claim Office Administrator Underwriter Designation Form |
Arkansas | December 12, 2013 |
| Employers Intent To Accept Or Controvert Claim |
Arkansas | December 12, 2013 |
| Coverage Coding Sheet For Attorneys |
South Carolina | November 19, 2013 |
| Insurers Notice Of Name Or Address Change |
Michigan | November 17, 2013 |
| Notice Of Compensation Payments |
Michigan | November 17, 2013 |
| Security Agreement For Certificate Of Deposit And Notice Of Security Interest |
Louisiana | November 17, 2013 |
| Second Injury Board Knowledge Questionnaire |
Louisiana | November 17, 2013 |
| First Report Of Injury Or Illness |
Louisiana | November 17, 2013 |
| Employers First Report Of Injury Or Fatality |
Massachusetts | October 30, 2013 |
| Agreement For Redeeming Liability By Lump Sum - For Injuries On Or After 11-1-86 |
Massachusetts | October 30, 2013 |
| Request For Certification Of Dispute |
Minnesota | October 18, 2013 |
| Statement Of Wages (For Injuries Occurring On Or Before June 23 1996) |
Pennsylvania | October 10, 2013 |
| Notice Stopping Temporary Compensation |
Pennsylvania | October 9, 2013 |
| Notice Of Change Of Workers Compensation Disability Status |
Pennsylvania | October 9, 2013 |
| Impairment Rating Determination Face Sheet |
Pennsylvania | October 9, 2013 |
| Statement Of Wages (For Injuries Occurring On And After June 24 1996) |
Pennsylvania | September 27, 2013 |
| Request For Permission For Major Surgery |
Rhode Island | August 22, 2013 |
| Claim Of Appeal To Appellate Division |
Rhode Island | August 22, 2013 |
| Objection To Tentative Order |
Ohio | August 19, 2013 |
| Self-Insurers Agreement As To Compensation On Account Of Death |
Ohio | August 19, 2013 |
| Unconditional And Continuing Guarantee |
Ohio | August 19, 2013 |
| Application For Additional Award For Violation Of Specific Safety Requirement |
Ohio | August 16, 2013 |
| Amended Payroll Report |
Ohio | August 16, 2013 |
| Acknowledgment Of The Self Insured Joint Settlement Agreement And Release |
Ohio | August 7, 2013 |
| Order For Dismissal |
New Jersey | July 29, 2013 |
| Employees Report Of Claim |
Michigan | July 29, 2013 |
| Notice Of Termination Of Liability |
Michigan | July 29, 2013 |
| Employers Basic Report Of Injury |
Michigan | July 29, 2013 |
| Notice Of Dispute |
Michigan | July 29, 2013 |
| Instructions For Notice Of Compensation Payments Form With Examples |
Michigan | July 29, 2013 |
| Insurers Notice Of Issuance Of Policy |
Michigan | July 29, 2013 |
| Settlement Contract Lump Sum Petition And Order |
Illinois | July 22, 2013 |
| Request For Prior Authorization Of Medication Form |
Ohio | July 15, 2013 |
| Wage Statement |
Ohio | July 15, 2013 |
| Application For Renewal Of Authorization To Operate As A Self-Insured Risk |
Ohio | July 15, 2013 |
