Documents

73

Official Form 441 "Notice of Further Investigation of Wokers' Compensation Claim" - Utah

Rate (4.7 / 5) 26 votes
Size: 172 KB
1 page

Official Form 307 "Medical Treatment Provider List" - Utah

Rate (4.4 / 5) 31 votes
Size: 420 KB
1 page

Form 308 "Authorization to Disclose, Release and Use Protected Health Information Permanent Total Disabilty Claims (15 Years of Records) HIPAA Compliant" - Utah

Rate (4.7 / 5) 24 votes
Size: 85 KB
1 page

Form 308 "Authorization to Disclose, Release and Use Protected Health Information Non-permanent Total Disabilty Claims (10 Years of Records) HIPAA Compliant" - Utah

Rate (4.6 / 5) 28 votes
Size: 85 KB
1 page

Form 205 "Authorization to Release Industrial Accident Division Records" - Utah

Rate (4.8 / 5) 8 votes
Size: 171 KB
1 page

Official Form 303 "Utah Bankruptcy and Insolvency Endorsement" - Utah

Rate (4.6 / 5) 16 votes
Size: 1 MB
1 page

Form 219 "Statement of Compensation" - Utah

Rate (4.5 / 5) 16 votes
Size: 213 KB
1 page

Official Form 089 "Employee Notification of Denial of Claim" - Utah

Rate (4.4 / 5) 12 votes
Size: 1 MB
1 page

Official Form 130 "Final Report of Injury and Statement of Total Losses" - Utah

Rate (4.5 / 5) 35 votes
Size: 1 MB
1 page

Form 044 "Employee's Notification of Intent to Leave Locality or State, and to Change Doctor or Hospital" - Utah

Rate (4.3 / 5) 20 votes
Size: 192 KB
1 page

Form 123 "Physician's Initial Report of Work Injury or Occupational Disease" - Utah

Rate (4.4 / 5) 15 votes
Size: 185 KB
1 page

Form 102 "Application to Change Doctors" - Utah

Rate (4.3 / 5) 6 votes
Size: 191 KB
1 page

Form 223 "Authorization Request for Medical Treatment/Carrier Response" - Utah

Rate (4.8 / 5) 17 votes
Size: 230 KB
4 pages

Form 206 "Insurer/Employer Initial Reemployment Report for Injured Worker" - Utah

Rate (4.3 / 5) 19 votes
Size: 229 KB
1 page

Official Form 109 "Application for Self-insurance" - Utah

Rate (4.3 / 5) 29 votes
Size: 1 MB
10 pages

Official Form 142 "Statement of Suspension of Benefits" - Utah

Rate (4.8 / 5) 17 votes
Size: 1 MB
1 page

Form 302 "Request for Medical Records" - Utah

Rate (4.5 / 5) 10 votes
Size: 162 KB
1 page

Official Form 141 "Statement of Benefits Paid" - Utah

Rate (4.8 / 5) 9 votes
Size: 5 MB
1 page

Form 043 "Attending Physician's Statement" - Utah

Rate (4.7 / 5) 20 votes
Size: 194 KB
1 page

Form 001 "Application for Hearing - Industrial Accident Claim" - Utah

Rate (4.6 / 5) 19 votes
Size: 404 KB
5 pages

Form 026 "Application for Hearing - Occupational Disease Claim" - Utah

Rate (4.4 / 5) 25 votes
Size: 255 KB
5 pages

Form 152 "Appointment of Counsel" - Utah

Rate (4.4 / 5) 18 votes
Size: 101 KB
1 page

Form 027 "Occupational Disease Claim" - Utah

Rate (4.5 / 5) 19 votes
Size: 187 KB
3 pages

Form 024 "Application for Hearing Medical Care Provider" - Utah

Rate (4.3 / 5) 6 votes
Size: 31 KB
2 pages

Official Form 350 "Emergency Medical Service Provider Exposure Report Form" - Utah

Rate (4.7 / 5) 19 votes
Size: 68 KB
1 page

Form 502 "Application for Hearing Failure of Diligent Pursuit" - Utah

Rate (4.5 / 5) 22 votes
Size: 83 KB
2 pages

Form 602 "Application for Hearing Noncooperation" - Utah

Rate (4.6 / 5) 16 votes
Size: 88 KB
2 pages

Form 402 "Application for Hearing for Termination or Reduction of Compensation" - Utah

Rate (4.7 / 5) 22 votes
Size: 90 KB
2 pages

Form 403 "Persons With Knowledge List" - Utah

Rate (4.8 / 5) 19 votes
Size: 84 KB
2 pages

Form 404 "Notice of Filing Application for Hearing for Termination or Reduction of Compensation" - Utah

Rate (4.3 / 5) 12 votes
Size: 87 KB
3 pages

Form 025 "Application for Hearing-dependent's Benefits and/or Burial Benefits - Industrial Accident Claim" - Utah

Rate (4.3 / 5) 35 votes
Size: 186 KB
3 pages

Instructions for Form 025 "Application for Hearing-dependent's Benefits and/or Burial Benefits - Industrial Accident Claim" - Utah

Rate (4.4 / 5) 23 votes
Size: 310 KB
2 pages

Instructions for Form 027 "Application for Hearing-Dependent's Benefits and/or Burial Benefits - Occupational Disease Claim" - Utah

Rate (4.5 / 5) 24 votes
Size: 310 KB
2 pages

Instructions for Form 001 "Application for Hearing - Industrial Accident Claim" - Utah

Rate (4.8 / 5) 27 votes
Size: 420 KB
2 pages

Official Form 213E "Self-insurance Aggregate Surety Bond" - Utah

Rate (4.7 / 5) 19 votes
Size: 1 MB
3 pages

Form 221B "Restorative Services Authorization/Denial - Upper Extremity" - Utah

Rate (4.6 / 5) 18 votes
Size: 309 KB
2 pages

Form 221A "Restorative Services Authorization/Denial - Spine" - Utah

Rate (4.6 / 5) 7 votes
Size: 314 KB
2 pages

Form 122C "First Report of Injury or Illness" - Utah

Rate (4.4 / 5) 34 votes
Size: 1 MB
2 pages

Official Form 215E "Agreement of Assumption and Guaranty of Workers' Compensation" - Utah

Rate (4.8 / 5) 10 votes
Size: 1 MB
2 pages

Form 221C "Restorative Services Authorization/Denial - Lower Extremity" - Utah

Rate (4.3 / 5) 17 votes
Size: 310 KB
2 pages