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WebFile Attorney Registration Form
WebFile Attorney Registration FormAttorneys must be added to the Commission's database under their law firm before WebFile access can be granted. This form must be completed and emailed to...
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Pre-Hearing Statement Order - Claimants Claim and Employers Application
Pre-Hearing Statement Order - Claimants Claim and Employers Application
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Medical Care Provider Application Response Form
Medical Care Provider Application Response Form
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Mediation Consent Form A - All Parties Have Legal Counsel
Mediation Consent Form A - All Parties Have Legal Counsel
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Mediation Consent Form B - All Parties Do Not Have Legal Counsel
Mediation Consent Form B - All Parties Do Not Have Legal Counsel
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Amputation Chart
Amputation ChartThe treating physician completes this form to provide information to support an injured worker’s claim which resulted in amputation to the foot, toes or metatarsal bones and/or hand,...
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Request for Issue Mediation
Request for Issue Mediation This form may be used by injured workers, deceased worker claimants, medical provider claimants, employers, insurers, claim administrators, and legal counsel to request...
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Request for Full and Final Mediation
Request for Full and Final Mediation This form may be used by legal counsel to request Full and Final Mediation by a Commission mediator as a means of reaching a compromise settlement. Filing...
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Pre Mediation Statement Form (Awarded Claim)
Pre Mediation Statement Form (Awarded Claim)This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It is designed for use in a...
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Pre-Mediation Statement Form (All Claims)
Pre-Mediation Statement Form (All Claims)This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It is designed for use in any...
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Pre-Mediation Statement Form (Contested Original Claim)
Pre-Mediation Statement Form (Contested Original Claim)This form is for voluntary use in Full And Final Mediation as a way to convey information to the mediator prior to the mediation. It has been...
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