Claims Management Services

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
	Safety Cornerstones Express Resource
	Medical Bill Review and Cost Containment Services Brochure
	Claims Management Services Brochure
	Early Claim Reporting Saves Claim Dollars
	Service Beyond Price
	Getting Started with Online Claims Reporting

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
	Initial Treatment Authorization
	Pharmacy Authorization Letter
	No Injury Certificate
	No Treatment Requested Letter
	Wage Statement Letter
	Wage Statement
Frequently Asked Questions

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Florida
	New Employer Welcome Letter
	First Report of Injury (Form DFS-F2-DWC- I)
	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

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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

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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

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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

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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

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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

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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