Claimwire Newsletter - December 2016

Keeping Workers' Comp Professionals Up-to-Date

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12/30/16  General  0 comment(s) 

Keeping Workers' Compensation
Professionals Up-to-Date 
   A free service from your friends at Claimwire and our Sponsors
December 2016
State Form Changes
The following states have modified and/or added forms

  • Wage Claim FormView
  • Employee’s Notice to Revoke Rejection of Terms of the AZ WC LawView
  • Notice of Professional Employer AgreementView
  • Preauthorization Request and Payer Decision (Limited to chronic pain and/or opioids)View
  • Discrimination StatementView
  • Carrier's Notification of Scheduled InjuryView
  • Worker's Supplemental Claim for CompensationView
  • Self-Provider of Medical Benefits FormView
  • Petition for Rearrangement or Readjustment CompensationView
  • Petition to Reopen a ClaimView
  • Claim for Dependent's Benefits - FatalityView
  • Employer's Report of Industrial InjuryView
  • Uninsured Employer Complaint FormView
  • Report of Significant Work Exposure to Bodily Fluids or Other Infectious MaterialsView

  • Medical Mileage Expense Form In English/Spanish (for mileage after 1/1/17)View

  • Employer's First Report of Injury or Occupational DiseaseView
  • Memo of Payment of Workers' CompensationView
  • Notice of Controversion Memo of Denial of Workers' CompensationView
  • Notice of Final Payment of Compensation PaymentsView

  • Employer's Report Of Industrial InjuryView

  • Application for Resolution - Interlocutory ReliefView
  • Medical Report – Injury/Hearing Loss/Psychological ConditionView
  • Physician's Medical Report-Occupational DiseaseView
  • Motion to ReopenView
  • Hearing Loss Stipulation and Contested IssuesView
  • Safety Violation Alleged by Plaintiff/EmployeeView
  • Safety Violation Alleged by Defendant/EmployerView
  • Average Weekly Wage CertificationView
  • Kentucky Division Of Workers Compensation FatalityView
  • Average Weekly Wage Certification - Post InjuryView
  • Average Weekly Wage Certification - ConcurrentView
  • Plaintiff’s Employment HistoryView
  • Plaintiff’s Chronological Medical HistoryView
  • Request to Substitute Party and Continue BenefitsView
  • Agreement as to Compensation and Order Approving Settlement-FATALITYView
  • Agreement as to Compensation and Order Approving Settlement-INJURYView
  • Notice of Claim Denial or AcceptanceView
  • Medical DisputeView
  • Request for Expedited Medical DeterminationView
  • Statement of Proposed Stipulations and Notice of Contested Issues-INJURYView
  • Statement of Proposed Stipulations and Notice of Contested Issues-HLView
  • Statement of Proposed Stipulations and Notice of Contested Issues-ODView

  • Statement of Wage Information (Average Weekly Wage) 14 WeeksView

  • Insurer's Notice of Issuance of PolicyView

  • Employer's Report of Industrial Injury or Occupational DiseaseView

  • Employer's First Report of Work-Related Injury/IllnessView

  • Physician's StatementView

  • Appointment of CounselView
  • Authorization to Disclose, Release and Use Protected Health Information (HIPAA Compliant)View
  • Independent Contractor or Covered Worker?View
  • Request for ConfidentialityView

  • Application for Temporary Total Disability BenefitsView
  • Employer's Notice of ChangeView
  • Claim for WagesView
  • Out of State Employer QuestionnaireView
  • Instructions for completing the Wyoming Quarterly UI/WC and UI Only Summary Report FormView

  • Rehabilitation Action ReportView
  • Pre-Hearing StatementView
  • Agreement and Undertaking (Self-Insured Employer)View
  • Waiver of Service by Registered or Certified Mail for Claimants and Authorized RepresentativesView
  • Work Capacity Evaluation Psychiatric/Psychological ConditionsView
  • Work Capacity Evaluation Cardiovascular/Pulmonary ConditionsView
  • Agreement and Undertaking (Insurance Carrier)View
  • Rehabilitation Plan and AwardView
  • Request of EarningsView
  • Application for Security Deposit DeterminationView
  • Request for Examination and/or TreatmentView
  • Employee’s Claim for CompensationView
  • Payment of Compensation Without AwardView
  • Carrier's Report of Issuance of PolicyView
  • Rehabilitation Maintenance CertificateView
  • Work Capacity Evaluation Musculoskeletal ConditionsView
To access forms for all 50 states
News and Announcements from States
  • CWCI Study Examines Cumulative Trauma Claims in the California WC System View
  • Idaho EDI Claims Release 3.0 Information Update  View
  • Five Things You Need To Know About BWCS Provider Fee Schedules View
  • Workers’ compensation rates in Texas among nation’s lowest View

  • Insurity Acquires Systema Software View
  • Federal court ruling means OSHA drug testing limitations are now live View
  • Incorporating Telemedicine into Workers’ Compensation Care View
  • Announcement regarding Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) “Re- Review” Process View
  • Final Rule Issued to Improve Tracking of Workplace Injuries and Illnesses View

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