Claims Management Services

State Claim Forms & Publications

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

Alabama
Alabama Department of Industrial Relations - Workers' Compensation
http://dir.alabama.gov/wc/
First Report of Injury
	http://dir.alabama.gov/docs/forms/wc_first_report_injury.pdf
Fraud
	http://dir.alabama.gov/docs/posters/wc_fraudposter.pdf

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Florida
Florida Department of Financial Services Div.
http://www.fldfs.com/wc/index.htm
First Report of Injury
	http://www.fldfs.com/wc/pdf/DFS-F2-DWC-1.pdf
Wage Statement
	http://www.fldfs.com/wc/pdf/DFS-F2-DWC-1a.pdf
Fraud
http://www.fldfs.com/fraud
Benefit Delivery Process
	http://www.fldfs.com/wc/pdf/flowchart.pdf
Return to Work Program
	http://www.fldfs.com/wc/pdf/ObligationToRehire.pdf
Florida Workers' Compensation System Guide
	Florida Work Comp System Guide-v2.pdf

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Georgia
Georgia State Board of Workers' Compensation
http://www.sbwc.georgia.gov
First Report of Injury
	GA_SBWC_Employer's_First_Report_of_Injury_WC-1_Rev2007_07.pdf
Wage Statement
	GA_SBWC_Wage_Statement_WC-6_Rev2009_07.pdf
Employer Information
	GA_SBWC_Employer_Information_Rev2007_07.pdf
Employee Handbook
	GA_SBWC_Employee_Handbook-English_Ed2007_07.pdf (English)
	GA_SBWC_Employee_Handbook-Spanish_Ed2007_07.pdf (Spanish)

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Kentucky
Kentucky Office of Workers' Claims
http://www.labor.ky.gov/workersclaims/
First Report of Injury
	http://www.labor.ky.gov/NR/rdonlyres/190EAAB8-EEC6-4C1B-8341-A1981D10465A/0/IA1.pdf
Wage Certification
	http://www.labor.ky.gov/NR/rdonlyres/B2762968-634F-4C35-B72D-EF69B8E2BA99/0/aww1.pdf
Workers' Compensation Guidebook
	2008 Kentucky Workers Compensation Guidebook.pdf

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Mississippi
Mississippi Workers' Compensation Commission
http://www.mwcc.state.ms.us/
First Report of Injury
	http://www.mwcc.state.ms.us/forms/1streport.pdf
Frequently Asked Questions
http://www.mwcc.state.ms.us/FAQ/faq.html

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North Carolina
North Carolina Industrial Commission
http://www.ic.nc.gov/
N.C. Workers’ Compensation Notice to Injured Workers and Employers
	http://www.ic.nc.gov/ncic/pages/form17.pdf
Employer’s Report of Employee’s Injury or Occupational Disease to the Industrial Commission
	http://www.ic.nc.gov/ncic/pages/form19int.pdf
Statement of Days Worked and Earnings of Injured Employee
	http://www.ic.nc.gov/ncic/pages/form22.pdf
Other Forms
http://www.ic.nc.gov/ncic/pages/forms.htm
Frequently Asked Questions
http://www.ic.nc.gov/ncic/pages/bus&ind.htm
Chapter 97. Workers’ Compensation Act
http://www.ic.nc.gov/ncic/pages/ch97toc.htm

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South Carolina
South Carolina Workers' Compensation Commission
http://www.wcc.state.sc.us/
South Carolina Workers' Compensation Commission
http://wcc.sc.gov/Welcome+and+Overview/Workers+Comp+SC/
South Carolina Department of Insurance
http://www.doi.sc.gov/
South Carolina Secretary of State
http://www.scsos.com
First Report of Injury
	http://www.wcc.state.sc.us/NR/rdonlyres/9D6F75F5-0CAF-459E-8A81-E8B17D343F52/0/Form12A.pdf
Other Forms
http://www.wcc.state.sc.us/Welcome+and+Overview/Forms/

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Tennessee
Tennessee Department of Labor & Workforce Development
http://www.state.tn.us/labor-wfd/wcomp.html
Tennessee Department of Commerce and Insurance
http://www.state.tn.us/commerce/
Tennessee Department of State
http://www.state.tn.us/sos/
First Report of Injury
	http://www.state.tn.us/labor-wfd/forms/c20.pdf
Wage Statement
	http://www.state.tn.us/labor-wfd/forms/c41.pdf