Forms & Reporting Procedures

• C-84(PDF, 188KB)
  Request for temporary disability benefits while you are off work and recuperating
• C-86 Motion(PDF, 56KB)
  A C-86 Motion is a request for (action) on your claim.
• MEDCO-14 Physician's Report of Workability(PDF, 418KB)
  for your provider of record to complete after every office visit involving a workers' compensation claim
• Medical release of records and list of past physicians(PDF, 81KB)
• Reporting an accident or injury /Accident Report Form for Injured Employees/ARFIE-SI(PDF, 370KB)
• Use only for Sick Leave Replenishment only for claims with dates of injury prior to 4-1-2012(PDF, 570KB)