Claims Management Services
Claim Forms
General Forms
When a Workplace Accident Occurs Poster
When a Workplace Accident Occurs Poster-Spanish
What information is Needed When an Accident Occurs
Pharmacy Authorization Letter
Job Demand Analysis
My Safety Key - Online Safety Resources
Medical Bill Review and Cost Containment Services Brochure
Claims Management Services Brochure
Prompt Claim Reporting Saves Claim Dollars
Service Beyond Price
Getting Started with Online Claims Reporting
State Specific Forms and Frequently Asked Questions
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Alabama
New Employer Welcome Letter
First Report of Injury (WCC Form 2)
Fraud Poster
Initial Treatment Authorization
Pharmacy Authorization Letter
No Injury Certificate
No Treatment Requested Letter
Wage Statement Letter
Wage Statement
Frequently Asked Questions
Florida
New Employer Welcome Letter
First Report of Injury (Form DFS-F2-DWC-1)
Anti-Fraud Notice
Initial Treatment Authorization
Pharmacy Authorization Letter
No Injury Certificate
No Treatment Requested Letter
Wage Statement (Form DFS-F2-DWC-1a)
Employer Workers' Compensation Facts Flyer (Form DFS-F2-DWC-65)
Employer Workers' Compensation Facts Flyer-Spanish (Form DFS-F2-DWC-66)
Worker Workers' Compensation Facts Flyer (Form DFS-F2-DWC-60)
Worker Workers' Compensation Facts Flyer-Spanish (Form DFS-F2-DWC-61)
Application for Drug-Free Workplace Premium Credit Program (Form FFVAMIC DFWP-FL form 01)
Certification of Employer Workplace Safety Program Premium Credit (Form FFVAMIC Safety-FL form 01)
Benefit Delivery Process (v04-2006)
Florida Workers' Compensation System Guide (v08-2008)
Frequently Asked Questions
Georgia
New Employer Welcome Letter
First Report of Injury (Form WC-I)
Stop Workers' Compensation Fraud Poster
Authorization and Consent to Release Information (Form WC-207)
Initial Treatment Authorization
Pharmacy Authorization Letter
No Injury Certificate
No Treatment Requested Letter
Wage Statement (Form WC-6)
Job Analysis (Form WC-240a)
SBWC Employer Information (Ed.07-2007)
SBWC Employee Handbook-English (Ed.07-2007)
SBWC Employee Handbook-Spanish (Ed.07-2007)
Frequently Asked Questions
Kentucky
New Employer Welcome Letter
First Report of Injury (Form lA-I)
Medical Waiver and Consent (Form 106)
Notice of Designated Physician (Form 113)
Average Weekly Wage Certification (Form AWW-l)
Request for Payment for Services or Reimbursement for Compensable Expenses (Form 114)
Pharmacy Authorization Letter
No Injury Certificate
No Treatment Requested Letter
Kentucky 2008 Guidebook to Workers' Compensation
Frequently Asked Questions
Mississippi
New Employer Welcome Letter
First Report of Injury (Form IAIABC lA-I)
Notice of Coverage Compliance Poster
Initial Treatment Authorization
Pharmacy Authorization Letter
Authorization for Use or Disclosure of Protected Health Information
Notice of My Physician Choice
Wage Statement
No Injury Certificate
No Treatment Requested Letter
Frequently Asked Questions
North Carolina
New Employer Welcome Letter
First Report of Injury (Form 19)
Notice of Accident to Employer and Claim of Employee, Representative, or Dependent (Form 18)
Notice to Injured Workers and Employers (Form 17)
Statement of Days Worked and Earnings of Injured Employee - Wage Statement (Form 22)
Authorization for Release of Medical Records
Initial Treatment Authorization
Pharmacy Authorization Letter
No Injury Certificate
No Treatment Requested Letter
Other Forms
Chapter 97 Workers Compensation Act
Frequently Asked Questions
South Carolina
New Employer Welcome Letter
First Report of Injury (WCC Form 12-A)
Initial Treatment Authorization
Pharmacy Authorization Letter
Wage Statement (WCC Form #20)
No Injury Certificate
No Treatment Requested Letter
Other Forms
Frequently Asked Questions
Tennessee
New Employer Welcome Letter
First Report of Injury (Form LB-0021)
Workers' Compensation Insurance Compliance Poster
Medical Waiver and Consent (Form C-31)
Employee' s Choice of Physician (Form C-42G)
Initial Treatment Authorization
Pharmacy Authorization Letter
Wage Statement (Form C-4I)
No Injury Certificate
No Treatment Requested Letter
What Employers Should Know
Frequently Asked Questions
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