Workers Compensation
If you file a case with the Clerk of Court, you must include the Filing Information and Final Disposition forms(PDF, 214KB).
- Application for Lump Sum/Advance Payment(PDF, 259KB)
- Attorney Affidavit for No-Liability Stipulations(PDF, 422KB)
- Attorney Fee Approval(PDF, 100KB)
- Attorney Leave of Absence(PDF, 609KB)
- Attorney Withdrawal/Lien(PDF, 99KB)
- Authorization and Consent to Release Information(PDF, 18KB)
- Bill of Rights for the Injured Worker(PDF, 20KB)
- Bill of Rights for the Injured Worker - Spanish(PDF, 18KB)
- Case Progress Report(PDF, 22KB)
- Change of Physician/Additional Treatment by Consent(PDF, 11KB)
- Conformed Panel Of Physicians(PDF, 110KB)
- Conformed Panel Of Physicians - Spanish(PDF, 6KB)
- Consolidated Yearly Report of Medical Only Cases(PDF, 10KB)
- Credit/Reduction in Benefits(PDF, 10KB)
- Employer's First Report of Injury(PDF, 29KB)
- Individualized Rehabilitation Plan(PDF, 26KB)
- Job Analysis(PDF, 431KB)
- Medical Report(PDF, 13KB)
- Motion/Objection to Motion(PDF, 17KB)
- Notice of Claim/Request for Hearing/Request for Mediation(PDF, 27KB)
- Notice of Payment or Suspension of Benefits(PDF, 23KB)
- Notice of Payment or Suspension of Death Benefits(PDF, 22KB)
- Notice of Election or Rejection of Workers' Compensation(PDF, 17KB)
- Notice of Intent to Become a Party at Interest(PDF, 15KB)
- Notice of Representation(PDF, 610KB)
- Notice of Use of Servicing Agent(PDF, 10KB)
- Notice to Controvert(PDF, 110KB)
- Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations(PDF, 11KB)
- Notice to Employee of Offer of Suitable Employment(PDF, 611KB)
- Panel of Physicians(PDF, 579KB)
- Panel of Physicians - Spanish(PDF, 6KB)
- Petition for Appointment of Temporary Guardianship of Minor(PDF, 27KB)
- Petition for Appointment of Temporary Guardianship of Legally Incapacitated(PDF, 28KB)
- Rehabilitation Transmittal Form(PDF, 20KB)
- Request for Authorization of Treatment or Testing by Authorized Medical Provider(PDF, 97KB)
- Request for Catastrophic Designation(PDF, 20KB)
- Request for Copy of Board Records(PDF, 16KB)
- Request for Settlement Mediation(PDF, 16KB)
- Request for Rehabilitation(PDF, 21KB)
- Request for Rehabilitation Closure(PDF, 22KB)
- Request/Objection for Change of Physician/Additional Treatment(PDF, 19KB)
- Standard Coverage Form Group Self-Insurance Fund Members(PDF, 13KB)
- Wage Statement(PDF, 14KB)
- WC/MCO Panel(PDF, 112KB)
- WC/MCO Panel - Spanish(PDF, 7KB)