| Form No. |
Form Type and Title |
Price |
Buy Now
|
| Claims |
|
|
|
| 8aWCA |
Notice of Accidental Injury or Occupational Disease& |
$12.99 |
|
| 8WC |
Employer’s First Report of Occupational Injury or Disease Form |
$12.99 |
|
| 8WC |
Employer’s First Report of Occupational Injury or Disease Form& |
$12.99 |
|
| 9 WCA |
Memo of Payment of Disability Compensation& |
$12.99 |
|
| 76 WCA 1-94 |
Wage Schedule& |
$12.99 |
|
| 76 WCA1 |
Supplemental Wage Schedule& |
$12.99 |
|
| 13 WCA 7-89 |
Employer’s Supplemental Report of Injury |
$12.99 |
|
| 9 WCA-1 9-02 |
Memo of Denial of Workers’ Compensation Benefits& |
$12.99 |
|
| 75 WCA-1 6-94 |
NH Workers’ Compensation Medical Forms& |
$12.99 |
|
| 10 WCA 10/98 |
Memo of Permanent Impairment Award& |
$12.99 |
|
| 74 WCA 7-89 |
Report of Extended Disability& |
$12.99 |
|
| |
NH Workers’ Compensation Task Analysis& |
$12.99 |
|
| 15 WCA 10-99 |
Lump Sum Settlement Forms& |
$12.99 |
|
| WC-3PR-1 7-89 |
Release and Settlement of Claim& |
$12.99 |
|
| |
Authorization for Compensation for Death& |
$12.99 |
|
| |
Authorization to Permit Witness at Medical Examination& |
$12.99 |
|
| 53WC |
Employee’s Statement of Employment Status& |
$12.99 |
|
| 53-A |
Notice to Suspend Payment of Workers’ Compensation Benefits& |
$12.99 |
|
| Self Insurance |
|
|
|
| |
Self-Insurance Application& |
$12.99 |
|
| |
Self-Insurance Questionnaire& |
$12.99 |
|
| |
Self-Insurance Surety Bond& |
$12.99 |
|
| |
Certificate of Insurance& |
$12.99 |
|
| |
Endorsement& |
$12.99 |
|
| |
Annual Financial Statement& |
$12.99 |
|
| |
General Purpose Rider& |
$12.99 |
|
| |
Guarantee Proposal& |
$12.99 |
|
| |
Outstanding Liabilities& |
$12.99 |
|
| |
Parent Company Agreement& |
$12.99 |
|
| |
Securities Deposit Agreement& |
$12.99 |
|
| |
Securities Deposit Agreement Past Liability& |
$12.99 |
|
| Second Injury Fund |
|
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|
| |
Application for Second Injury Fund& |
$12.99 |
|
| |
Request for Reimbursement from the Second Injury Fund& |
$12.99 |
|
| |
Schedule of Reimbursable Payments& |
$12.99 |
|
| |
Second Injury Fund Affidavit of Employer Knowledge& |
$12.99 |
|
| |
Second Injury Fund Certification by Physician& |
$12.99 |
|
| |
Application for Reimbursement of Paid Adjusted Total Disability& |
$12.99 |
|
| |
Application for Reimbursement of Paid Combined Earnings& |
$12.99 |
|
| Third Party Administrators |
|
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|
| |
Security Deposit Agreement for Third Party Administrator& |
$12.99 |
|
| |
Application for Certificate of Authority& |
$12.99 |
|
| |
Notice of Contract Between Third Party Administrator and Self Insurer& |
$12.99 |
|
| |
Third Party Administration Bond& |
$12.99 |
|
| |
Biographical Affidavit& |
$12.99 |
|
| Job Modification |
|
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|
| |
Request for Job Modification Plan Approval& |
$12.99 |
|
| Vocational Rehabilitation |
|
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|
| |
NH Vocational Rehabilitation Provider Certification Form& |
$12.99 |
|
| IWRP |
Individual Written Rehabilitation Plan& |
$12.99 |
|
| |
Vocational Rehabilitation Training Agreement& |
$12.99 |
|
| |
Rehabilitation Closure Form& |
$12.99 |
|
| |
Rehabilitation Referral Form& |
$12.99 |
|
| DES 605 |
New Hampshire New Hire Reporting Form |
$12.99 |
|
