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 282 State Forms found

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DOCTOR'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS

 Form 5021 (Rev. 5) 10/2015

EMPLOYER'S REPORT OF OCCUPATIONAL INJURY OR ILLNESS

 FORM 5020 (Rev7) June 2002

Workers Compensation Claim Form DWC 1 and Notice of Potential Eligibility

 DWC 1 Rev. 1/1/2016

ADDENDUM TO APPLICATION FOR ADJUDICATION OF CLAIM TO IDENTIFY LEGAL ENTITY EMPLOYING INJURED WORKER

 WCAB Form 2 (8/2011)

Additional Panel Request-8 Cal. Code of Regulations section 31.7

 QME form 31.7 (1/2024)

AME or QME Declaration of Service of Medical - Legal Report (Lab. Code 4062.3(i))

 QME Form 122 Rev. February 2009

2020 ANNUAL REPORT OF ADJUSTING LOCATIONS

 Form DWC-857 Rev. 10/20

ANSWER TO APPLICATION FOR ADJUDICATION OF CLAIM

 DWC/ WCAB Form 10 (REV. 11/2008)

APPLICATION FOR A CERTIFICATE OF CONSENT TO ADMINISTER WORKERS' COMPENSATION SELF INSURANCE CLAIMS

 Form A4-50 (Rev 8/96)

APPLICATION FOR ADJUDICATION OF CLAIM

 DWC/WCAB Form 1A (5/2020)

APPLICATION FOR ADJUDICATION OF CLAIM (Death Case)

 DIA WCAB Form 2 DIA-2 (Rev. 7/81)

APPLICATION FOR APPOINTMENT AS QUALIFIED MEDICAL EVALUATOR

 QME Form 100 (rev.9/2015)

PETITION FOR BENEFITS FOR SERIOUS AND WILLFULL MISCONDUCT OF EMPLOYER PURSUANT TO LABOR CODE SECTION 4553

No Form Number No Form/Rev Date

APPLICATION FOR DISCRETIONARY PAYMENTS FROM THE UNINSURED EMPLOYERS' FUND

 DWC / UEF 50 Rev: 11/2008

PETITION FOR DISCRIMINATION BENEFITS PURSUANT TO LABOR CODE SECTION 132a

No Form Number No Form/Rev Date
Disclaimer: These forms may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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