Workers Compensation

If you file a case with the Clerk of Court, you must include the Filing Information and Final Disposition forms.

Application for Lump Sum/Advance Payment 

Attorney Affidavit for No-Liability Stipulations

Attorney Fee Approval 

Attorney Leave of Absence 

Attorney Withdrawal/Lien 

Authorization and Consent to Release Information

Bill of Rights for the Injured Worker

Bill of Rights for the Injured Worker - Spanish

Case Progress Report 

Change of Physician/Additional Treatment by Consent 

Conformed Panel Of Physicians

Conformed Panel Of Physicians - Spanish 

Consolidated Yearly Report of Medical Only Cases

Credit/Reduction in Benefits 

Employer's First Report of Injury 

Individualized Rehabilitation Plan

Job Analysis

Medical Report

Motion/Objection to Motion

Notice of Claim/Request for Hearing/Request for Mediation

Notice of Payment or Suspension of Benefits

Notice of Payment or Suspension of Death Benefits

Notice of Election or Rejection of Workers' Compensation

Notice of Intent to Become a Party at Interest

Notice of Representation 

Notice of Use of Servicing Agent

Notice to Controvert

Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations

Notice to Employee of Offer of Suitable Employment

Panel of Physicians

Panel of Physicians -Spanish

Petition for Appointment of Temporary Guardianship of Minor

Petition for Appointment of Temporary Guardianship of Legally Incapacitated

Rehabilitation Transmittal Form

Request for Authorization of Treatment or Testing by Authorized Medical Provider

Request for Catastrophic Designation

Request for Copy of Board Records

Request for Settlement Mediation

Request for Rehabilitation

Request for Rehabilitation Closure

Request/Objection for Change of Physician/Additional Treatment

Standard Coverage Form Group Self-Insurance Fund Members

Wage Statement

WC/MCO Panel 

WC/MCO Panel - Spanish