Tools & Documents for Workers

Filter

Authorization for Release of Protected Health Information

Authorization for release of protected health information (HIPAA compliant)

Type
PDF
Last Updated
2016-03-18

Certificate of Compliance

You must submit this form to your employer's workers' compensation insurer or to your employer within 14 days of its receipt. Your workers' compensation benefits may be suspended if you do not timely submit this Certification. You would be entitled to all suspended benefits after this Certification is provided to your insurer, if you are otherwise eligible for benefits.

Type
PDF
Last Updated
2016-03-18

Choice of Physician

When you are injured at work or become sick because of something that happened at work, the law gives you the right to choose your own doctor in any field or specialty of medicine for medical treatment.

Type
PDF
Last Updated
2016-03-18

Common Workers' Comp Terms

Type
PDF
Last Updated
2016-08-11

Employee’s Monthly Report of Earnings

Type
PDF
Last Updated
2016-03-18

First Fill Program Pharmacy Card

Type
DOC
Last Updated
2016-06-14

Mileage Claim Form

Workers’ Compensation Mileage Claim Form

Type
PDF
Last Updated
2016-03-18