The following is a listing and links to Workers' Compensation Claims forms, procedures and Medical Provider Network information.
If you need to report a claim, go to the Report an Injury page.
If you can't find what you need here, call us at (877)625-6566.
Employer Claims & Medical Provider Network Kit Workers Compensation Worksite & MPN Poster (10-10) Checklist - What to do When an Injury Occurs First Aid Only Claims - What You Need to Know Universal Pain Assessment Tool
Employee Declination of Treatment Form Medical Records Authorization Form Injury - Body Part Checklist Claim Form - DWC1 Claim Form - Employers Report of Injury (5020) Employee Fraud Statement Form OSHA Work Related Injuries Log - Form 300 Supervisors Investigation Report Form