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Forms: Workers Compensation

The following two forms MUST be included with the papers you file for all non-domestic civil case filings.

1.General Civil Case Filing Information Form (Non-Domestic)

2.General Civil Case Final Disposition Form 

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 Documents to Parties 
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