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 20 State Forms found

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MEMORANDUM OF ONE-TIME PAYMENT

 WCB-3A (Effective 6-1-2026)

WAGE STATEMENT

 WCB-2 (Effective 6-1-2026)

SCHEDULE OF DEPENDENT(S) AND FILING STATUS STATEMENT

 WCB-2A (effective 09/27/2023)

FRINGE BENEFITS WORKSHEET

 WCB-2B (Effective 6-1-2026)

MEMORANDUM OF PAYMENT

 WCB-3 (Effective 6-1-2026)

MODIFICATION OF COMPENSATION

 WCB-4M (Effective 6-1-2026)

CERTIFICATE OF DISCONTINUANCE OR REDUCTION OF COMPENSATION

 WCB-8 (Effective 6-1-2026)

LUMP SUM SETTLEMENT

 WCB-10 (Effective 6-1-2026)

STATEMENT OF COMPENSATION PAID

 WCB-11A (Effective 6-1-2026)

MOTION FOR AWARD OF FEES AND DISBURSEMENTS

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

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 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)
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