| Title | State |
Last Updated |
| Employer To Provide Coverage For Persons Performing Public Or Community Service |
Kansas | January 23, 2018 |
| Election Of Employer To Provide Coverage For Volunteer Workers |
Kansas | January 23, 2018 |
| Election Of Employer To Cover Employees |
Kansas | January 23, 2018 |
| Election Of Employee Not To Accept Coverage |
Kansas | January 23, 2018 |
| Subpoena |
Idaho | January 23, 2018 |
| Employers First Report Of Occupational Injury Or Disease |
Maine | January 12, 2018 |
| Request For Transcript |
Maryland | January 12, 2018 |
| Application For Lump Sum |
Maryland | January 12, 2018 |
| Request For Hearing For Referral To Maryland Insurance Fraud Division |
Maryland | January 12, 2018 |
| Election Of Coverage |
Idaho | January 4, 2018 |
| Answer To Complaint |
Idaho | January 4, 2018 |
| Notice Of Election To Voluntarily Exclude Spouse From Coverage |
New York | November 22, 2017 |
| Application For Acceptance Of Insurance Form |
New York | November 22, 2017 |
| Employers Application To Have Association Union Or Trustee Plan Accepted As Employers Plan |
New York | November 22, 2017 |
| Notice Of Election Of Corporation To Exclude Shareholder Officers From Disability Coverage |
New York | November 22, 2017 |
| Employers Statement For Purpose Of Terminating Status As Covered Employer |
New York | November 22, 2017 |
| Authorization For Release Of Information (Patient Waiver) |
Iowa | May 16, 2017 |
| Petition To Determine Disfigurement |
Delaware | April 20, 2017 |
| Petition To Determine Additional Compensation Due To Injured Employee |
Delaware | April 20, 2017 |
| Petition For Review |
Delaware | April 20, 2017 |
| Application For Supplemental Income Beneifts (Spanish) |
Texas | April 17, 2017 |
| Request To Adjust Average Weekly Wage For Seasonal Employee (Spanish) |
Texas | April 17, 2017 |
| Employees Election For Commuted (Lump Sum) Impairment Income Benefits |
Texas | April 17, 2017 |
| Carriers Request For Reduction Of Income Benefits Due To Contribution |
Texas | April 17, 2017 |
| Notice To Employee - Intention To Request Commission Permission To Adjust Benefits |
Texas | April 17, 2017 |
| Notice To Employee - Intention To Request Commission Permission To Adjust Benefits (Spanish) |
Texas | April 17, 2017 |
| Request To Adjust Average Weekly Wage For Seasonal Employee |
Texas | April 17, 2017 |
| Application For Supplemental Income Beneifts |
Texas | April 17, 2017 |
| Request For Extension Of Maximum Medical Improvement For Spinal Surgery |
Texas | April 17, 2017 |
| Employees Request For Acceleration Of Impairment Income Benefits (Spanish) |
Texas | April 17, 2017 |
| Employers Report For Reimbursement Of Voluntary Payment |
Texas | April 17, 2017 |
| Employees Request For Acceleration Of Impairment Income Benefits |
Texas | April 17, 2017 |
| Statement Of Wage Information |
Maryland | February 28, 2017 |
| Medical EDI Compliance Coordinator And Trading Partner Notification |
Texas | January 27, 2017 |
| EDI Trading Partner Profile |
Texas | January 27, 2017 |
| Attorney Application For Web Access |
Texas | January 27, 2017 |
| Claim Of Unpaid Wages |
South Dakota | December 9, 2016 |
| Change Of Name Address Or EFT |
Wyoming | December 8, 2016 |
| New Registration |
Wyoming | December 8, 2016 |
| Claim For Non Medical Services |
Wyoming | December 8, 2016 |
| Affidavit For Death Benefits |
New York | December 2, 2016 |
| ADR Program Final Disposition Of Claim |
New York | December 2, 2016 |
| Designated Doctor Certification Application |
Texas | November 30, 2016 |
| Employers Report Of Industrial Injury |
Hawaii | November 30, 2016 |
| Aggregate Annual Reporting Form - Reporting Period 7-01 To 6-30 |
Vermont | November 30, 2016 |
| Semi Annual Report Workers Compensation Tax Report For Self Insured Employers |
Idaho | November 30, 2016 |
| Employer Certificate And Request For Claims History |
Idaho | November 30, 2016 |
| Claimants Request For Personal Workers Compensation Records |
Idaho | November 30, 2016 |
| Reimbursement Of Health Care Travel Expenses |
Idaho | November 30, 2016 |
| Employer Certificate And Claims History Release |
Idaho | November 30, 2016 |
