Claims Management Services

General Forms

	What to do when an accident occurs?
	What information is needed when an accident occurs?
	Initial Treatment Authorization
	Pharmacy Authorization Letter
	No Injury Certificate
	No Treatment Requested Letter
	Job Demand Analysis
	Safety Cornerstones Express Resource
	Medical Bill Review & Cost Containment Brochure
	Claims Management Services Brochure

State Specific Claim Forms and Frequently Asked Questions

Alabama | Florida | Georgia | Kentucky | Mississippi | North Carolina | South Carolina | Tennessee

Alabama
	New Employer Welcome Letter
	First Report of Injury (WCC Form 2)
	Fraud Poster
	Wage Statement Letter
	Wage Statement
Frequently Asked Questions

top

Florida
	New Employer Welcome Letter
	First Report of Injury (Form DFS-F2-DWC- I)
	Anti-Fraud Notice
	Employer Workers' Compensation Facts Flyer (Form DFS-F2-DWC-65)
	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)
	Wage Statement (Form DFS-F2-DWC-1a)
	Benefit Delivery Process (v04-2006)
	Florida Workers' Compensation System Guide (v08-2008)
Frequently Asked Questions

top

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)
	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

top

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)
	Kentucky 2008 Guidebook to Workers' Compensation
Frequently Asked Questions

top

Mississippi
	New Employer Welcome Letter
	First Report of Injury (Form IAIABC lA-I)
	Application for Drug-Free Workplace Premium Credit Program
	Wage Statement
Frequently Asked Questions

top

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)
Other Forms
Chapter 97 Workers Compensation Act
Frequently Asked Questions

top

South Carolina
	New Employer Welcome Letter
	First Report of Injury (WCC Form 12-A)
	Wage Statement (WCC Form #20)
Other Forms
Frequently Asked Questions

top

Tennessee
	New Employer Welcome Letter
	First Report of Injury (Form LB-0021)
	Medical Waiver and Consent (Form C-31)
	Employee' s Choice of Physician (Form C-42G)
	Wage Statement (Form C-4I)
Frequently Asked Questions