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WISCONSIN
Complete Claim Kit State Website First Report of Injury (FROI) Medical Authorizations Poster - Notice to Injured Workers & Employees
WORKERS' COMPENSATION CLAIM KITS
MN
MINNESOTA
Complete Claim Kit State Website First Report of Injury (FROI) Report of Work Ability Employee's Rights and Responsibilities
Click on a state to find the necessary documents to report a workers' compensation claim
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ALASKA
Complete Claim Kit State Website First Report of Injury Safety and Health Protection on the job notice Workplace Notice
ALABAMA
Complete Claim Kit State Website First Report of Injury Workplace Notice
ARKANSAS
ARIZONA
Complete Claim Kit State Website First Report of Injury Workplace Posting Posting Notice – Work Exposure to Bodily Fluids Posting Notice – Workplace Exposure to Methicillin-Resistant MRSA, Spinal Meningitis or TB Posting Notice – Report of Significant Work Exposure to Bodily Fluids
CALIFORNIA
Complete Claim Kit State Website First Report of Injury Claim Form (DWC1) Predesignation of Personal Physician Notice to Employees (DWC7) Return to Work Form
COLORADO
Complete Claim Kit State Website First Report of Injury Notice of Injury Poster Workplace Notice (English) Workplace Notice (Spanish)
CONNECTICUT
Complete Claim Kit State Website First Report of Injury Notice to Employees Medical Authorizations Medical & Work Status Form
DELAWARE
Complete Claim Kit State Website First Report of Injury Workplace Notice (English)
FLORIDA
Complete Claim Kit State Website First Report of Injury Workplace Notice (English) Workplace Notice (Spanish) Wage Statement
GEORGIA
Complete Claim Kit State Website First Report of Injury Workplace Notice (English) Workplace Notice (Spanish) Fraud Notice GA State Board of WC (English) GA State Board of WC (Spanish)
HAWAII
Complete Claim Kit State Website First Report of Injury Notice to Employees Wage Statement
IOWA
Complete Claim Kit State Website First Report of Injury Medical Authorizations
IDAHO
Complete Claim Kit State Website First Report of Injury FROI instructions Notice of Insurance
ILLINOIS
Complete Claim Kit State Website First Report of Injury ICPN Workplace Notice ICPN Workplace Notice (Spanish)
INDIANA
Complete Claim Kit State Website First Report of Injury Workplace Notice Workplace Notice (Spanish)
KANSAS
Complete Claim Kit State Website First Report of Injury Informational page for injured workers (English) Informational page for injured workers (Spanish) Workers' Compensation Rights and Responsibilities
KENTUCKY
Complete Claim Kit State Website First Report of Injury Form 114 Request for payment for services or reimbursement Medical Authorization Notice of Designated Physician State Posting
LOUISIANA
Complete Claim Kit State Website First Report of Injury Workplace Poster
MASSACHUSETTS
Complete Claim Kit State Website First Report of Injury Workplace Folder
MARYLAND
Complete Claim Kit State Website First Report of Injury Workplace Poster Wage Statement
MAINE
Complete Claim Kit State Website First Report of Injury Workplace Posting Wage Statement
MICHIGAN
Complete Claim Kit State Website First Report of Injury Michigan Workers' Disability Compensation Rights & Responsibilities Employees Right Posting
MISSOURI
Complete Claim Kit State Website First Report of Injury Roles and Responsibilities Form (English) Roles and Responsibilities Form (Spanish) Medical Authorization
MISSISSIPPI
Complete Claim Kit State Website First Report of Injury Workplace Poster (English) Workplace Poster (Spanish) Mississippi WC Physician Choice
MONTANA
Complete Claim Kit State Website First Report of Injury
NEBRASKA
Complete Claim Kit State Website First Report of Injury Choosing a Doctor (English and Spanish) Notice of Employees Right to Choose a Doctor (English and Spanish)
NORTH DAKOTA
NORTH CAROLINA
Complete Claim Kit State Website First Report of Injury NC WC Notice to Injured Workers and Employers (form 17- English) NC WC Notice to Injured Workers and Employers (form 17-Spanish) Notice of Accident to Employer (form 18-English) Notice of Accident to Employer (form 18-Spanish) Employer's Report of Employee's Injury or Occupational Disease to the Industrial Commission (form 19) Statement of Days Worked and Earnings of Injured Employee (form 22)
NEW HAMPSHIRE
Complete Claim Kit State Website First Report of Injury Employer's Supplemental Report of Injury Notice of Accidental Injury or Disease (LAB 500) Wage Schedule Notice of Compliance
NEW JERSEY
Complete Claim Kit State Website First Report of Injury Employer's Guide to Workers' Compensation Insurance Carrier Contact Form
NEW MEXICO
Complete Claim Kit State Website First Report of Injury Workplace Poster Medical Authorization Notice of Accident Poster Employer Guidebook
NEVADA
Complete Claim Kit State Website First Report of Injury (C-3) Notice of Injury or Occupational Disease (C-1) Posting Notice Notice to Employees Rights & Benefits Employees Claim for Compensation of Initial Treatment (form C-4) Employees Wage Information (Form D-8)
NEW YORK
Complete Claim Kit State Website First Report of Injury First Report of Injury Instructions Employees Statement of Rights Wage Statement
OHIO
OKLAHOMA
Complete Claim Kit State Website First Report of Injury Guide for Employers Notice and Instruction to Employers and Employees (English) Notice and Instruction to Employers and Employees (Spanish)
OREGON
Complete Claim Kit State Website First Report of Injury Order Notice of Compliance Folder Guide for Injured Workers
PENNSYLVANIA
Complete Claim Kit State Website First Report of Injury Employee Workplace Notice (English) Employee Workplace Notice (Spanish) Wage Statement
RHODE ISLAND
Complete Claim Kit State Website First Report of Injury Workplace Poster (English) Workplace Poster (Spanish) Compliance Poster (English) Compliance Poster (Spanish) Notification of Claim of Compensable Injury
SOUTH CAROLINA
Complete Claim Kit State Website First Report of Injury Wage Statement
SOUTH DAKOTA
Complete Claim Kit State Website First Report of Injury Safety "Team Work Makes the Dream Work" posting "Safety First" posting - English "Safety First" posting - Spanish Safety "Together Everyone Achieves More" posting
TENNESSEE
Complete Claim Kit State Website First Report of Injury WC Employer Rights Form C-42 Employee's Choice of Physician Form C-42 Employee's Choice of Physican - Spanish State Posting State Posting - Spanish Medical Waiver and Consent Wage Statement
TEXAS
Complete Claim Kit State Website First Report of Injury Wage Statement Notice #5 to Employees – WC (English) Notice #5 to Employees – WC (Spanish) Notice #6 to Employees – WC (English) Notice #6 to Employees – WC (Spanish) Notice #7 to Employees – WC (English) Notice #7 to Employees – WC (Spanish) Notice #8 Required WC Coverage (English) Notice #8 Required WC Coverage (Spanish) Notice #9 Regarding Certain Work Related Communicable Diseases and Eligibility for WC Benefits (English) Notice #9 Regarding Certain Work Related Communicable Diseases and Eligibility for WC Benefits (Spanish)
UTAH
Complete Claim Kit State Website First Report of Injury Workers' Compensation Notice (English) Workers' Compensation Notice (Spanish) Employee's Guide to Workers' Compensation Employers Guide to Workers' Compensation
VERMONT
Complete Claim Kit State Website First Report of Injury Wage Statement Employer's Liability & Workers' Compensation Notice (English) Employer's Liability & Workers' Compensation Notice (Spanish) Posting of Safety Records Worker's Compensation Reinstatement Rights Medical Authorization
VIRGINIA
Complete Claim Kit State Website First Report of Injury Posting Notice (English) Posting Notice (Spanish) Wage Statement
WEST VIRGINIA
WASHINGTON DC
Complete Claim Kit State Website First Report of Injury Employees Rights & Responsibilities (English) Employees Rights & Responsibilities (Spanish) Wage Schedule
State is monopolistic. No information available.
WASHINGTON
WYOMING
Complete Claim Kit State Website First Report of Injury (FROI) Medical Authorizations Poster – Notice to Injured Workers & Employees
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