Claims Materials
Arizona Claims Materials
- Employers Report of Industrial Injury Form ICA-04-0101
- Information for employers for workers compensation Arizona
- Information for Injured Workers Arizona
- Medical Services Order Form – Arizona, Colorado, Utah
- Workers Report of Injury – Arizona
California Claims Materials
- Claims Management
- Employee MPN Implementation Notice
- Employee’s Claim for Workers’ Compensation Benefits DWC-1
- First Report of Injury Form 5020
- Medical Service Order form California
- MPN Distribution Acknowledgement
- MPN Handout English
- MPN Handout Spanish
- MPN Implementation Instructions
- MPN Poster English
- MPN Poster Spanish
- Notice to Employees Poster for Injuries Caused on the Job (DWC 7)
- WCAB Office Information Sheet
Colorado Claims Materials
- Employers Report of Injury – Colorado
- Information for Employers for Workers’ Compensation in CO
- Information for Injured Workers Colorado in CO
- Medical Services Order Form – Arizona, Colorado, Utah
- Notice of Injury Poster
- Workers Compensation Information – Colorado
- Workers’ Compensation Poster
- Workers’ Compensation Poster (Spanish)
Idaho Claims Materials
- Employers Report of Injury – Idaho
- Information for Employers for Workers Compensation – Idaho
- Information for Injured Workers – Idaho
- Medical Services Order Form – Idaho, Nevada, Oregon
Nevada Claims Materials
- Employers Report of Injury – Nevada
- Information for Employers for Workers Compensation – Nevada
- Information for Injured Workers – Nevada
- Medical Services Order Form – Idaho, Nevada, Oregon
- Notice of Injury or Occupational Disease – Nevada
Oregon Claims Materials
- Employers’ Report of Injury – Oregon
- Information for Employers for Workers Compensation – Oregon
- Information for Injured Workers – Oregon
- Medical Services Order Form – Idaho, Nevada, Oregon
- Spanish Claim Form – Oregon
