Publications and Forms
A form to be completed by the insurance carrier regarding the eligibility of an injured worker for the physical rehabilitation benefit available through the Second Injury Fund.
Questions and affidavit for claimant regarding completeness of medical information submitted, form E.
A form to be completed by any party to refer a seriously injured worker who may possibly qualify for physical rehabilitation benefits through the Second Injury Fund.
A form for use by health care provider to determine case status information to file a medical fee dispute application.