Health Care MutualCaptive Insurance Company "Your Workers' Compensation Partner" |
Download FormsFor your convenience, all forms on our website are in Policy FormsHCM Payment PlanPolicy Holder Agreement Supplemental Application (Updated 2011) Surplus Note Employee Concentration Supplement Application Claims KitStatement of the InjuredReporting a Claim Health Questionaire HCMCIC Contact Sheet Supervisors Report WC-001 (Updated 09/2011) WC-006 (Updated 09/2011) WC-207 (Updated 09/2011) WC-240 (Updated 09/2011) NOTE: You must have the Adobe® Acrobat® Reader installed on your computer in order to view and print these forms. This is a free program. Click the link below for more information.
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Adobe® Acrobat® PDF format.