Here is an impairment rating template compatible with the state’s rule set
Impairment Rating Template for State Specific Rule Set (Word file)
Administrative Rule Set
has a state specific rule set. Please see the link to the labor department below for more information.
Physician’s Initial Report of Work Injury or Occupational Disease
Here is a link to Physician’s Initial Report
Permanent Partial Disability Worksheet
Here is a link to Permanent Partial Disability Worksheet
Here is a link to Industrial Accidents Division
Schedule of Medical Fees
Here is a link to Medical Fee Standards (located on right menu bar)
Employer’s First Report of Injury
Here is a link to First Report of Injury
Request for Authorization
Here is a link to Request for Medical Treatment/Carrier Response (Form 223)
Information on this page is subject to change as state rules and fee schedules are updated regularly. If there is any information that is incorrect or in need of revision, please contact us at email@example.com.