Commonly Used Workers’ Comp Forms
It probably comes as no surprise that there is often LOTS of paperwork involved when navigating workers’ compensation claims. To make it easier to obtain some of the most commonly used forms, we’ve compiled a list of links below so you can directly download any required paperwork. Follow the links below to view the printable pdf forms.
- Form 1002– Notice of Payment
Description: Form to be completed by the Employer/Insurer and sent to the injured employee.
- Form 1008– Disputed Claim for Compensation
Description: Form to be filed with the Workers’ Compensation district office when there is any disputed issue in a claim
- Form 1009– Disputed Claim for Medical Treatment
Description: Form to be filed with the Workers’ Compensation Medical Services Director when there is a Disputed Claim for Medical Treatment.
- Form 1010– Request of Authorization/Carrier or Self-Insured Employer Response
Description: Request of authorization/carrier or self insured employer response
- Form 1020– Employee’s Monthly Report of Earnings
Description: Form filed monthly with the employer’s insurer by the injured worker to report any earnings (Workers’ compensation)
- Form 1025ee– Employee’s Certificate of Compliance
Description: Form filed by injured workers explaining rights and responsibilities while receiving workers’ compensation benefits and penalties for failure to comply
- Form 1121– Physician Choice Form
Description: Form to be completed by the injured worker when selecting their physician of choice
If you have questions about any of the forms above, or are unable to locate the form(s) you need for your particular case, please contact us, and we’ll be happy to assist.
