Form | Description | Doc | Fee | |
---|---|---|---|---|
16 | Agreement for Permanent Disability/ Disfigurement Compensation | Doc | $50.00 if Claimant Represented | |
16A |
Agreement for Permanent Disability/ Disfigurement Compensation (injuries after July 1, 2007) |
Doc | $50.00 if Claimant Represented | |
17 | Receipt of Compensation | Doc | No Fee | |
20 | Statement of Earning of Injured Employee | Doc | No Fee | |
24 | Application for Lump Sum Award | Doc | $50.00 | |
27 | Subpoena | Doc | No Fee | |
30 | Request for Commission Review (Appellate Panel Review) | Doc | $150 | |
32 | Request to Waive Filing Fee | Doc | No Fee | |
50 | Employee's Notice of Claim or Hearing Request | Doc | $50/ Hearing Request only | |
52 | Employee's Notice of Claim or Hearing Request (Death Claim) | Doc | $50.00/ Hearing Request only | |
58 | Pre-Hearing Brief | Doc | No Fee | |
59 | Appellant's Informational Brief | Doc | No Fee | |
65 | Occupational Disease Waiver | Doc | No Fee | |
S-2 | Notice of Third-Party Action (Employee) | Doc | No Fee | |
Single Commissioner Decision & Order Template | Doc | No Fee | ||
Appellate Panel Decision & Order Template | Doc | No Fee | ||
Certificate of Service | Doc | No Fee |