For your convenience, all forms on our website are in Adobe PDF Formatted Document Adobe® Acrobat® PDF format.
|Policy Holder Agreement|
|Supplemental Application||(Updated 2017)|
|Employee Concentration Supplement Application|
|Statement of the Injured|
|Reporting a Claim|
|HCMCIC Contact Sheet|
|WC-1||Employer's First Report of Injury (Revised 2017)|
|WC-6||Wage Statement (Revised 2017)|
|WC-207||Authorization and Consent to Release Information (Revised 2011)|
|WC-240||Notice to Employee of Offer of Suitable Employment (Revised 2014)|
|WC-BOR||Bill of Rights (2018)|
|WC-P1||Panel of Physicians (2018)|
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