| Title | State |
Last Updated |
| Medical Records Copies |
Utah | August 26, 2015 |
| Attending Physicians Statement |
Utah | August 26, 2015 |
| Corporate Officer Exclusion From Workers Compensation Or Employers Liability Coverage |
Utah | August 10, 2015 |
| Application For Hearing Medical Care Provider |
Utah | August 10, 2015 |
| Medical Treatment Provider List |
Utah | August 10, 2015 |
| Employees Notification Of Intent To Leave Locality Or State And To Change Doctor Or Hospital |
Utah | August 3, 2015 |
| Report Of Work-Related Injury Or Occupational Disease |
New York | August 3, 2015 |
| Notice Of Disputed Issues And Refusal To Pay Beneifts |
Texas | August 3, 2015 |
| Permanent Partial Disability Agreement |
Utah | July 29, 2015 |
| Renewal Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers |
New York | July 28, 2015 |
| Initial Application For License To Appear On Behalf Of Or Represent Carriers And-Or Self-Insurers |
New York | July 28, 2015 |
| Disagreement With Proposed Vocational Rehabilitation Plan |
Maryland | July 24, 2015 |
| Voluntary Agreement |
Connecticut | May 29, 2015 |
| Initial Application By Employee Of Licensee Under Section 50 3-b Or 50 3-d To Appear Before WCB |
New York | May 4, 2015 |
| Stockholder Of Corporation Applying For License To Represent Self-Insurers |
New York | May 4, 2015 |
| Subpoena Or Subpoena Duces Tecum Or Subpeona Duces Tecum For Medical Record |
Maryland | April 14, 2015 |
| Request For Emergency Hearing |
Maryland | April 14, 2015 |
| Settlement Worksheet |
Maryland | April 13, 2015 |
| Power Of Attorney |
Texas | April 13, 2015 |
| Report Of Medical Evaluation |
Texas | April 13, 2015 |
| Indemnity Agreement By Parent Corporation For Wholly Owned Or Majority Owned Subsidiary |
Indiana | April 13, 2015 |
| Surety Bond |
Indiana | April 13, 2015 |
| Controversion Of Medical Claim |
Maryland | April 13, 2015 |
| Proposed Vocational Rehabilitation Plan |
Maryland | April 13, 2015 |
| Cover Sheet For Action On Claims On Appeal |
Maryland | April 13, 2015 |
| Request To Implead A Party |
Maryland | April 13, 2015 |
| Notice Of Treatment Issue(s)-Disputed Bill Issue(s) |
New York | April 13, 2015 |
| Education Services Order Form |
Connecticut | April 13, 2015 |
| Report Of Temporary Total Disability |
Indiana | April 13, 2015 |
| Medical Fee Dispute Resolution Request |
Texas | April 13, 2015 |
| Medical Interlocutory Order Request |
Texas | April 13, 2015 |
| Return To Work Reimbursement Program For Employers |
Texas | April 13, 2015 |
| Surety Bond For Certified Self-Insurance Liabilities |
Texas | April 13, 2015 |
| Self-Insurers Agreement To Post Documentary Irrevocable Standby Letter Of Credit |
Texas | April 13, 2015 |
| Parental Guaranty |
Texas | April 13, 2015 |
| Documentary Irrevocable Standby Letter Of Credit |
Texas | April 13, 2015 |
| Documentary Irrevocable Standby Letter Of Credit (Confirmation) |
Texas | April 13, 2015 |
| Description Of Injured Employees Employment |
Texas | April 13, 2015 |
| Employers Contest Of Compensability |
Texas | April 13, 2015 |
| Reclamo Del Empleado Para Compensacion Por Una Lesion Reclacionada Con El Trabajo O Enfermedad Ocupacional |
Texas | April 13, 2015 |
| Request For A Medical Contested Case Or SOAH Hearing |
Texas | April 13, 2015 |
| Written Request For Interlocutory Order |
Texas | April 13, 2015 |
| Designation Of Insurance Carriers Austin Representative |
Texas | April 13, 2015 |
| Required Medical Examination Notice Or Request For Order |
Texas | April 13, 2015 |
| Statement Of Registration (Section 13n-WCL) |
New York | April 13, 2015 |
| Annual Statement |
Kansas | April 13, 2015 |
| Cancellation Of Election Of Employer To Provide Coverage |
Kansas | April 13, 2015 |
| Cancellation Of Election Of A Noncompensated Volunteer Officer Director Or Trustee |
Kansas | April 13, 2015 |
| Cancellation Of Election Not To Accept Coverage |
Kansas | April 13, 2015 |
| Cancellation Of Election Of Employer To Provide Coverage For Volunteer Workers |
Kansas | April 13, 2015 |
