Workers' Compensation

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  Employee’s Notice of Injury or Occupational Disease & Claim for Compensation

  TWCC-41E/S $89.00
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  Employee’s Quarterly Report of Earning

  LAWC1026 $39.00
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  Employee’s Report of Claim

  MIBWC-117 $69.00
• 

  Employee’s Request for Acceleration of Impairment Income Benefits

  TWCC-46 $129.00
• 

  Employee’s Request for Payment of Advance Compensation

  TWCC-47 $89.00
• 

  Employee’s Request that Comp be Reinstated after Unsuccessful Trial Return to Work

  NCWC28U $69.00
• 

  Employee’s Request to Change Treating Doctors

  TWCC-53 $89.00
• 

  Employees Wage Statement for Multiple Employments

  TWCC-3ME $89.00
• 

  Employer Notice of No Coverage or Termination of Coverage

  TWCC-5 $89.00
• 

  Employer’s Accident Report

  VAWC-3 $89.00
• 

  Employer’s Admission of Employee’s Right to Compensation

  NCWC60 $69.00
• 

  Employer’s Answer to Request for Hearing

  SCWC51 $69.00
• 

  Employer’s Answer to Request for Hearing, Death Case

  SCWC53 $69.00
• 

  Employer’s Application for Hearing

  VAWC-5A $89.00
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  Employer’s Basic Report of Injury

  MIBWC-100 $89.00
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  Employer’s First Report of Injury

  COWC1 $89.00