Compensation Claims Templates

This document is used for filing a compensation claim for payroll operations judicial assignment in New York.

This Form is used to notify individuals in New York (Spanish) that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement under WCL 32 is approved.

This form is used in New York to notify individuals that they may be responsible for medical costs if their compensation claim is disallowed or if they fail to prosecute. It also applies if an agreement pursuant to WCL 32 is approved.

This document is used for reporting a workplace injury in the state of Georgia, United States.

This Form is used for notifying individuals about the denial of their compensation claim in Tennessee. It is available in both English and Spanish.

This form is used to notify individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if certain agreements are approved under WCL 32.

This Form is used for filing a claim for compensation and giving notice of a third party action in the state of New York. It is available in Haitian Creole language.

This Form is used for employers in Texas to apply for reimbursement under the Return-To-Work program.

This form is used to notify individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if agreement pursuant to WCL 32 is approved.

This Form is used to inform individuals in New York that they may be responsible for medical costs if their compensation claim is disallowed or if an agreement pursuant to WCL 32 is approved. The form is available in French.

This Form is used for employers in New York to report the wages earned by an employee before their injury or illness.

This form is used for providing notice to individuals in New York who may be responsible for medical costs if their compensation claim is not pursued, disallowed, or if an agreement is approved. It is written in Russian.

This document is a notice that informs individuals in New York (Chinese) of their potential responsibility for medical costs if their compensation claim is unsuccessful or if an agreement under WCL 32 is approved.

This form is used to notify individuals in New York of their potential responsibility for medical costs in the event that their compensation claim is disallowed or if an agreement pursuant to WCL 32 is approved. The form is available in Korean.

This form is used for notifying individuals in New York (Yiddish) that they may be responsible for medical costs if their compensation claim is denied, agreement pursuant to WCL 32 is approved, or if they fail to prosecute their claim.

This Form A-9 is used in New York to inform individuals that they may be responsible for medical costs if their compensation claim is not pursued, disallowed, or if an agreement under WCL 32 is approved.

This Form is used for making a claim against the City of Ceres, California.