Agency

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  Notice of Use of Servicing Agent

  GAWC121 $69.00
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  Notice that Payment of Compensation Has Been Stopped or Modified

  NYWC_C-8/8.6 $89.00
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  Notice that Right to Compensation is Controverted

  NYWC_C-7 $69.00
• 

  Notice to Chair of Carrier’s Action on Application for Reopening

  RB-679 $69.00
• 

  Notice to Chair of Carrier’s Action on Claim for Benefits

  NYWC_C-669 $69.00
• 

  Notice to Controvert

  GAWC3 $69.00
• 

  Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations

  GAWC104 $69.00
• 

  Notice to Employee of Offer of Suitable Employment

  GAWC240 $69.00
• 

  Notice to Employee of Payment of Compensation

  NCWC63 $69.00
• 

  Notice to IC of Assignment of Rehab Professional

  NCWC25N $69.00
• 

  Notification and Reporting Form

  DHEC2701 $149.00
• 

  Notification for Underground Storage Tanks

  EPANUST $199.00
• 

  Notification of First Payment (Cover)

  TWCC-26 $89.00
• 

  Notification of Initial Treatment

  FLWC8 $69.00
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  Notification of Intent to Drill a Water Well and Certification of Completion

  ALADEM60 $129.00
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  Notification Regarding Maximum Medical Improvement and/or Impairment Rating

  TWCC-28 $89.00