Affidavit for Time-Loss Compensation
Application for L.E.P. Compensation
Application to Reopen Claim
AP Rating Request
Appeal Cover Letter
Authorization for Release of Information
Change of Attending Physician Form
Confirmation of Witnesses (Board of Appeals)
Letter Enclosing Subpoena and Requesting CV
Letter with Interrogatories and Request for Production
Lost Warrant Form
Protest and Request for Reconsideration
Request for 20-Day Extension to Respond
Request for DME Report Only
Request for Specific Medical Records
Request for Wage Verification
Request IME Report
Request Updated Copy of File
Requests for Transcripts & Extension (Board of Appeals)
Statement for Pharmacy Services
Travel Reimbursement Request
Work Status
Activities of Daily Living Form
Examination Questionnaire
Injury Diary
Medical Expenses Worksheet
PI Documentation Checklist
