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Publications and Forms

Self-Insurer’s Statement of Outstanding Losses (WC-83)

An annual report of an individually self-insured employer’s outstanding losses.

Stipulation for Compromise Settlement (WC-G-11)

A form submitted to an Administration Law Judge for approval of the settlement of a workers' compensation case.

Substitution of Counsel (WC-237)

A request for substitution of counsel in a workers' compensation case.

Surplus Distribution Request (WC-265)

A form requesting authority to distribute surplus monies of a self-insured group trust.

Trust Quick Reference Due Dates (WC-193)

A quick reference for group trust reporting requirements.

Workers' Compensation Subpoena (WC-25-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a hearing.

Workers' Compensation Subpoena Duces Tecum (WC-25-A-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a hearing.

Workers' Compensation Subpoena Duces Tecum For Deposition (WC-25-C-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a deposition.

Workers' Compensation Subpoena For Deposition (WC-25-B-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a deposition.

Affidavit for Security Release (WC-264)

A sample affidavit for former self-insured employers requesting release of security.

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