Workers Compensation - Applications
- Application for Lump Sum or Advance Payment UT-134-WC
- Workers Compensation Application for Hearing UT-001-WC
- Application to Change Doctors UT-102-WC
- Authorization Request for Medical Procedures/Carrier Response UT-223-WC
- Authorization to Disclose, Release and Use Protected Health Information (HIPAA Compliant) UT-308-WC
- Authorization to Release Industrial Accident Division Records UT-205-WC
- Authorization to Release Labor Commission Records UT-046-WC
- Checklists - Worker's Compensation Claims US-04076BG
- Claim for Dependents Benefits and/or Burial Benefits UT-025-WC
- Claimant's First Set of Requests for Production US-01366
- Claimant's First Set of Interrogatories to Employer and Carrier US-01365
- Requests for Production of Documents to Carrier US-01367
- Insurance Carriers / Self-Insurers Notice of Further Investigation of a Workers Compensation Claim UT-441-WC
- Agreement of Employee Service Provider to Maintain Workers Compensation Insurance US-01625BG
- Insurance Company and Self-Insurer Final Report of Injury and Statement of Total Losses UT-130-WC
- Emergency Medical Service Provider Exposure Report Form UT-350-WC
- Medical Care Provider Application for Hearing UT-024-WC
- Medical Treatment Provider List UT-309-WC
- Medical Treatment Provider List UT-307-WC
- Employee Notification of Denial or Partial Denial of Claim UT-089-WC
- Employees Notification of Intent to Leave Locality or State, and to Change Doctor or Hospital UT-044-WC
- Physicians Initial Report of Work Injury or Occupational Disease UT-123-WC
- Attending Physicians Statement UT-043-WC
- Request for Medical Records/Copies UT-302-WC
- Request/Appeal for Additional Medical Information UT-310-WC
- Statement of Insurance Carrier or Self-Insurer with Respect to Discontinuance of Benefits UT-142-WC
- Initial Statement of Insurance Carrier or Self-Insurer with Respect to Payment of Benefits UT-141-WC
