| Title | State |
Last Updated |
| Persons With Knowledge List |
Utah | February 4, 2014 |
| URCA Participation Agreement |
Utah | February 4, 2014 |
| UMA Participation Agreement |
Utah | February 4, 2014 |
| UTA Participation Agreement |
Utah | February 4, 2014 |
| Notice Of Filing Application For Hearing For Termination Or Reduction Of Compensation |
Utah | February 4, 2014 |
| Authorization To Disclose Release And Use Protected Health Information (Adjudication) |
Utah | February 4, 2014 |
| Application For Hearing For Termination Or Reduction Of Compensation |
Utah | February 4, 2014 |
| Application For Hearing Failure Of Diligent Pursuit |
Utah | February 4, 2014 |
| AGC Participation Agreement |
Utah | February 4, 2014 |
| Combination Supplementary And Claim Summary Form |
Alabama | January 27, 2014 |
| Assessment Report 2012 |
Alabama | January 27, 2014 |
| Case Management Closure Instructions |
Tennessee | October 31, 2013 |
| Application For Appointment To The Medical Impairment Rating (MIR) Registry |
Tennessee | October 31, 2013 |
| Political Subdivisions Report Of Injury To Volunteer Firefighter |
New York | September 19, 2013 |
| Notice To Chair Of Carriers Action On Claim For Benefits |
New York | September 19, 2013 |
| Notice That Right To Compensation Is Controverted |
New York | September 19, 2013 |
| Modification Of Previous Report (ADR Program) |
New York | September 18, 2013 |
| Employers Statement Of Wage Earnings Preceeding The Date Of Accident |
New York | September 18, 2013 |
| Employers Report Of Work-Related Injury-Illness |
New York | September 18, 2013 |
| Cover Sheet-Application For Full Board Review |
New York | September 18, 2013 |
| Application For Advance On Periodic Payments Of Compensation |
New York | September 18, 2013 |
| Political Subdivisions Report Of Injury To Volunteer Ambulance Worker |
New York | September 13, 2013 |
| Notice Of Retainer And Appearance Or Notice Of Substitution And Appearance |
New York | September 12, 2013 |
| Practitioners Report of Independent Medical Examination |
New York | September 12, 2013 |
| Notice That Payment Of Compensation Has Been Stopped Or Modified |
New York | September 11, 2013 |
| Agreement As To Compensation Paid |
Delaware | September 6, 2013 |
| Restorative Services Authorization Denial (Upper Extremity) |
Utah | August 21, 2013 |
| Restorative Services Authorization Denial (Lower Extremity) |
Utah | August 21, 2013 |
| Medical Treatment Provider List (Adjudication) |
Utah | August 21, 2013 |
| Closure Report |
Maryland | July 29, 2013 |
| Employer Or Self-Insured Employer Request For Change Of Address |
Maryland | July 29, 2013 |
| Dependents Claim For Death Benefits |
Maryland | July 29, 2013 |
| Certification Of Funeral Expenses |
Maryland | July 29, 2013 |
| Insurers Termination Of Temporary Total Disability Benefits |
Maryland | July 29, 2013 |
| Application For Self-Insurance |
Maryland | July 29, 2013 |
| Authorization For Release Of Medical Records |
Connecticut | July 19, 2013 |
| Employers Wage Statement |
Texas | June 19, 2013 |
| Employers Report Of Injured Employees Change In Employment Status Resulting From Injury |
New York | June 18, 2013 |
| Attorney-Representatives Certification Of Form C-3 Or Notice Of Controversy |
New York | June 14, 2013 |
| Notice Of Suspension Of Compensation And Or Benefits |
Indiana | June 4, 2013 |
| Employer Medical Care Plans Information Packet And Forms |
Connecticut | April 5, 2013 |
| Permanent Total Disability Final Order |
Tennessee | April 3, 2013 |
| Medical Waiver And Consent |
Tennessee | April 3, 2013 |
| Medical Care Cost Containment Committee Review Request |
Tennessee | April 3, 2013 |
| Employees Choice Of Physician |
Tennessee | April 3, 2013 |
| Complaint For Penalties |
Maine | March 15, 2013 |
| Application For Wage Credit Rehabilitation Fund |
Maine | March 15, 2013 |
| Supplementary Report |
Alabama | March 14, 2013 |
| Claim Summary Form |
Alabama | March 14, 2013 |
| Application For Certification Of Drug Free Workplace Premium Credit Program |
Alabama | March 14, 2013 |
