Form # | Description | DOC | Filing Fee | |
16A |
Agreement for Permanent Disability / Disfigurement Compensation Please complete this form for injuries occurring after July 1, 2007. |
$50.00 if Claimant is represented |
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17 |
Receipt of Compensation |
No fee |
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18 |
Periodic Report |
No fee |
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19 |
Status Report and Compensation Receipt |
No fee |
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20 |
Statement of Earning of Injured Employee |
No fee |
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21 |
Employer's Request for Hearing |
$50.00 |
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27 |
Subpoena |
No fee |
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30 |
Request for Commission Review |
$150.00 |
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33 |
Hearing Postponed |
No fee |
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38 |
Employer’s Withdrawal of Election to Adopt the |
No fee |
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51 |
Employer's Answer to Request for Hearing |
No fee |
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53 |
Employer's Answer to Request for Hearing, Death Case |
No fee |
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54 |
Employer's Notice of Claim and/or Request for Hearing |
$50.00 |
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55 |
Second Injury Fund's Answer to Employee's Request for Hearing |
No fee |
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58 |
Pre-Hearing Brief |
No fee |
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59 |
Appellant’s Informal Brief |
No fee |
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65 |
Occupational Disease Waiver |
No fee |
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70 |
Mediator Report |
No fee |
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S-1 |
Notice of Third Party Action Employee Carrier |
No fee |
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S-3 |
Entitlement to Right of Action |
No fee |
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S-4 |
Court Certificate |
No fee |
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Single Commissioner Decision & Order | Doc | No fee | ||
Appellate Panel Decision & Order | Doc | No fee | ||
Certificate of Service | Doc |