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 64 State Forms found

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MOTION FOR AWARD OF FEES AND DISBURSEMENTS

 WCB-25 (eff. 1/1/13, rev. 10/15/15)

PETITION FOR REVIEW OF INCAPACITY

 WCB-120 (eff. 1/1/13)

EMPLOYEE PETITION FOR REVIEW OF INCAPACITY AND REQUEST FOR PROVISIONAL ORDER

 WCB-121 (eff. 1/1/13)

PETITION TO DETERMINE AVERAGE WEEKLY WAGE

 WCB-122 (eff. 1/1/13)

PETITION FOR AWARD OF COMPENSATION

 WCB-140 (eff 1/1/2013 rev 10/11/2023)

PETITION FOR AWARD OF COMPENSATION - FATAL

 WCB-150 (eff. 1/1/13)

PETITION FOR AWARD OF COMPENSATION - OCCUPATIONAL DISEASE LAW

 WCB-160 (eff. 1/1/13)

PETITION FOR RESTORATION

 WCB-170 (eff 1/1/13, rev 10/11/23)

PETITION FOR REINSTATEMENT

 WCB-171 (eff 1/1/13, rev 10/11/23)

PETITION TO DETERMINE EXTENT OF PERMANENT IMPAIRMENT

 WCB-180 (eff. 1/1/13)

PETITION FOR PAYMENT OF MEDICAL AND RELATED SERVICES

 WCB-190 (eff. 10/1/15)

PROVIDER'S PETITION FOR PAYMENT OF MEDICAL AND RELATED SERVICES

 WCB-190A (eff. 10/1/15)

PETITION TO REMEDY DISCRIMINATION

 WCB-195 (eff. 1/1/13)

PETITION FOR EXTENSION OF BENEFITS DUE TO EXTREME FINANCIAL HARDSHIP PURSUANT TO 39-A M.R.S.A. §213(1)

 WCB-213 (eff. 1/1/13)

PETITION FOR REVIEW OF EXTENDED BENEFITS AWARDED DUE TO EXTREME FINANCIAL HARDSHIP PURSUANT TO 39-A M.R.S.A. §213(1)(B)

 WCB-213A (eff. 1/1/13)
Disclaimer: These forms may not be the most recent version. Maine 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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