Looking for State Specific Forms and Regulatory Links?

You’ve come to the right place.

Visit our Employer FAQ page for answers to employer related questions.

For claims forms by state, click here.

State Forms & Regulatory Links

Alabama +

AL Fraud Poster

AL Application for Certification of Drug-Free Workplace Premium Credit

AL Application for Re-Certification of Drug-Free Workplace Premium Credit

AL Notice of Election to Accept or Reject an Insurance Deductible

AL - Notice to Exclude or Include Coverage for Himself, Officers or Members

Links

Dept of Industrial Relations and Workers Comp

Florida +

FL Anti-Fraud Notice

FL Notice of Election of Coverage

FL Revocation of Election of Coverage

FL Application for Drug-Free Workplace Premium Credit

FL Certification of Employer Workplace Safety Program Premium Credit

FL Deductible Plan Election

FL Battle Against Workers' Comp Fraud

FL Battle Against Workers' Comp Fraud - Spanish

Links

Bureau of Workers’ Compensation Fraud

Georgia +

State Board of Workers' Compensation Notice of Election or Rejection of Coverage - GA

GA Application for Certification or Annual Recertification of Drug-Free Workplace Premium Credit

GA Notice of Election to Accept or Reject an Insurance Deductible

Links

State Board of Workers’ Compensation

Indiana+

Notice for Workers' Compensation & Occupational Diseases Coverage - IN

IN Notice of Election to Accept or Reject an Insurance Deductible

Links

Workers’ Compensation Board of Indiana

Kentucky+

First Report of Injury [Form IA-1]

Employee's Notice of Rejection of Workers' Compensation Act - KY

KY Application for Certification of Drug-Free Workplace Program

KY Notice of Election to Accept or Reject an Insurance Deductible

Links

Workers’ Compensation of Kentucky

Mississippi +

Wage Statement

MS Notice of Election or Rejection of Workers' Compensation

MS Application for Certification of Drug-Free Workplace Program

Links

Workers’ Compensation Commission

North Carolina +

NC Exemption Form

Links

Industrial Commission
NCRB ERM-14 – Electronic Submission Only

South Carolina +

SC Corporate Officer Notice to Reject

SC Application for Drug-and Alcohol-Free Workplace Premium Credit

SC Notice of Election to Accept or Reject an Insurance Deductible

Links

Workers’ Compensation Commission

Tennessee +

TN Workers' Compensation Insurance Posting Notice

TN Election of Sole Proprietor or Partner to Come within the Provisions of Workers' Compensation Law [Form I-4]

TN Notice of Corporate Officer to Employer of Election Not to Accept Provisions of Workers' Compensation Act [Form I-6]

TN Application for Drug-Free Workplace Premium Credit

TN Notice of Election to Accept or Reject an Insurance Deductible

TN Workers' Compensation Insurance Posting Notice - Spanish

TN Notice of Corporate Officer's Revocation of Exemption [Form I-7]

TN Notice of Withdrawal [Form I-5]

Links

Bureau of Workers’ Compensation

Virginia +

VA Notice of Election of Coverage

VA Revocation of Prior Rejection of Coverage Form 17A

VA Application for Drug-Free Workplace Premium Credit

Links

Virginia Workers’ Compensation Commission
Option to file Rejection of Coverage Waiver Form 16A