Worker's Compensation Forms

FYI: Workers' Comp instructions and information are located at the Benefits Tab, Workers' Compensation

• ALL STATES EXCEPT CALIFORNIA AND OHIO:

WC AUTHORIZATION TO TREAT FORM, ALL STATES EXCEPT CALIFORNIA AND OHIO, CONCENTRA

• CALIFORNIA ONLY

WC AUTHORIZATION TO TREAT FORM, CALIFORNIA ONLY, CONCENTRA

• OHIO ONLY

80028128 OHIO WORKERS' COMPENSATION BUREAU (OHIO ONLY)