Best Practice
Forms
- AWW Minimum and Maximum Compensation Rates/Mileage Reimbursement Rate
- Notice of Payment, Modification, Suspension, Termination or Controversion of Compensation or Medical Benefits (LWC-WC-1002)
- First Report of Injury (LWC-WC-IA-1 aka LWC-WC-1007)
- Disputed Claim for Compensation (LWC-WC-1008)
- Disputed Claim for Medical Treatment (LWC-WC-1009)
- Request for Compromise or Lump Sum Settlement (LWC-WC-1011)
- Request for State IME (LWC-WC-1015)
- Employee’s Monthly Report of Earnings (LWC-WC-1020) (English)
- Employee’s Monthly Report of Earnings (LWC-WC-1020) (Spanish)
- Employee Certificate of Compliance (LWC-WC-1025.EE)
- Choice of Physician Form (LWC-WC-1121) (English)
- Choice of Physician Form (LWC-WC-1121) (Spanish)
- Notice of Claim with Second Injury Fund (SIB Form A)
- Second Injury Board Request for Reimbursement (SIB Form B)
- Second Injury Board Post-Hire Questionnaire (English)
- Second Injury Board Post-Hire Questionnaire (Spanish)
- Part-Time Acknowledgement Form
- Seasonal Employment Acknowledgment Form
