WORKERS' COMPENSATION FORMS C20 First Report of Injury C22 Notice of First Payment C23 Notice of Denial of Claim for Compensation C26 Notice of Change or Termination of Benefits C27 Notice of Controversy C28 Notice of Lawsuit C29 Final Report of Payment C30 Attending Physicians Report C30A Final Medical Report C31 Medical Waiver and Consent C32 Medical Report in Lieu of Deposition C33 Case Management Notification (NEW) C34 Form C34 Instructions C35 Utilization Review Notification C36-37 Utilization Review Closure C36-37 Form Completion Instructions C38 Case Management Registration C39 Provider Registration for Utilization Review C40A Request for Assistance (NEW) C40B Request for Benefit Review Conference (BRC) C40R Certificate of Readiness (NEW) C41 Wage Statement C42 Agreement Between Employer/Employee Choice of Physician C42 Agreement Between Employer/Employee Choice of Physician (Spanish) C42G Governmental Entities Agreement Between Employer/Employee Choice of Physician C43 Permanent Total Disability Final Order CMUR Guidelines Drug-Free Workplace Form I-1 Certificate of Insurer I-2 Notice of Cancellation I-3 Reduction in Workforce I-4 Sole Proprietor/Partner Selection I-5 Sole Proprietor/Partner Withdrawal of Election I-6 Corporate Officer Election Not to Accept I-7 Corporate Officer Withdrawal of Election I-8 Exempt Employers Notice of Acceptance I-9 Exempt Employers Withdrawal of Notice I-10 Heart Waiver I-11 Occupational Disease Waiver I-12 Epilepsy Waiver I-13 Waiver Withdrawal I-14 Leased Operator/Common Carrier Election I-15 Subcontractor/General Contractor Election I-16 Leased Operator/Common Carrier Withdrawal I-17 Subcontractor/General Contractor Withdrawal I-18 Notice of Discontinuance MIR Application for a Medical Impairment Rating MIR Application for Appointment to the Medical Impairment Rating Registry MIR Medical Waiver and Consent Form MIR Impairment Rating Report-5th Edition MIR Impairment Rating Report-6th Edition Posting Notice Posting Notice (Spanish) Request for Investigation Request for Investigation - Spanish Request for Settlement Approval SD1 Statistical Data Form SD1 Statistical Data Form fillable version