Workers' Compensation

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  Case Manager Registration

  NYWC_C-38 $39.00
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  Case Progress Report

  GAWC4 $89.00
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  Certificate of Insurance

  91d521786005 $129.00
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  Certificate of Insurance

  GENCOI $89.00
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  Certification of Complete Medical Reports

  NCWC25A $69.00
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  Change of Physician/Additional Treatment by Consent

  GAWC200A $69.00
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  Claim Cost Report

  FLWC13 $89.00
• 

  Claim for Compensation

  ARWCCFC $89.00
• 

  Claim for Review

  MIBWC-262 $89.00
• 

  Claim Summary Form

  ALWC4 $89.00
• 

  Claimant’s Authorization to Disclose Workers’ Compensation Records

  NYWC_OC-110A $69.00
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  Claimant’s Lump Sum Request/Respondent’s Position

  ARWCL $69.00
• 

  Cover Sheet & Rebuttal of Application for Board Review

  RB-89.1 $89.00
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  Credit Reduction of Benefits

  GAWC243 $69.00
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  Death/Permanent and Total Disability Acceptance/Update

  ARWCD $89.00
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  Decision/Order

  ILIC34 $89.00