Do & Don’t Claims
Employee Incident Investigation Report
Employee Certificate of Compliance
(LWC - WC 1025EE)
Employee Certificate of Compliance - Spanish
(LWC - WC 1025EE)
Employee Choice of Physician
(LWC - WC 1121)
Employee Mileage Form
Employee Monthly Report of Earnings
(LWC - WC 1020)
Employee Monthly Report of Earnings - Spanish
(LWC - WC 1020)
Employer Certificate of Compliance
(LWC - WC 1025ER)
HIPAA Compliant Medical Authorization
Louisiana Workers' Comp PHMQ
(SIB Form D)
Louisiana Workers' Comp PHMQ - Spanish
(SIB Form D)
Medical Authorization
On the Job Injury Checklist
Part Time Acknowledgment Form
Pharmacy First Fill Card
Refusal of Medical Treatment
Supervisor Report Form
Updated Medical Questionnaire
Witness Report Form
