Safety Resources

Release of Protected Health Information

Authorization for release of protected health information (HIPAA compliant) A copy of this authorization will suffice for the release of information and will have the same force and legal effect of the original.

Employee’s Monthly Report of Earnings

Your workers’ compensation benefits may be suspended if you do not timely submit this report.

Certificate of Compliance

You must submit this form to your employer's workers' compensation insurer or to your employer within 14 days of its receipt. Your benefits may be suspended if you do not timely submit this. You would be entitled to all suspended benefits after this certification is provided to your insurer, if you are otherwise eligible for benefits.

Louisiana Workforce Commission

Workers' Compensation and additional links for more information.

Choice of Physician

When you are injured at work or become sick because of something that happened at work, the law gives you the right to choose your own doctor in any field or specialty of medicine for medical treatment.

Mileage Claim Form

Workers’ Compensation Mileage Claim Form. List trip(s) taken such as home to doctor, home to hospital, identify doctor, pharmacy, hospital by name and address and return home