LA Workers' Compensation Commission

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  Disputed Claim for Compensation

  LAWC1008 $89.00
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  Employee and Employer Certificate of Compliance

  LAWC1025 $39.00
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  Employee’s Monthly Report of Earnings

  LAWC1020 $69.00
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  Employee’s Quarterly Report of Earning

  LAWC1026 $39.00
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  Employer’s Report of Occupational Injury & Illness Quarterly Summary

  LAWC1017A $149.00
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  Motion for Recognition of Right to Social Security Offset

  LAWC1005A $39.00
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  Notice of Payment

  LAWC1002 $69.00
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  Order Recognizing Right to Social Security Offset

  LAWC1005B $39.00
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  Request for Compromise and Lump Sum Settlement

  LAWC1011 $69.00
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  Request for Independent Medical Examination

  LAWC1015 $69.00
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  Request for Social Security Benefits Information

  LAWC1004 $89.00
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  Stop Payment Form

  LAWC1003 $89.00
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  Subpoena Packet

  LAWC1006 $69.00