Form C-1 Employee Claim

 

Form C-24 Employer’s Posting Notice

Form SF-1 First Report of Injury (Employer’s FROI Form IAIABC 1A-1)

Hearings

A hearing notice includes the following information:

 

 

Form H-24R Issues Form

Form C-2 Statement of Wage Information

Form H-25R Request for Action on Filed Issues

Form C-24R Request to Enter Appearance of Counsel

Form C-25R Request to Strike Appearance of Counsel

Form H-28R Request for Continuance of Hearing

Form H-26R Request for Emergency Hearing

Form H-29R Request for Postponement of Emergency Hearing

Form C-90R Request for Document Correction

Form H-27R Request for Rehearing

Form H-30R Request for Modification

 

Form H-33R Request to Implead a Party

Form H-32 Controversion of Medical Claim

Form H-12 Request for a Hearing on Previously Withdrawn Issues

Form C-06 Insurer’s Termination of Temporary Total Disability Benefits

Form H-37 Uninsured Employer – Claimant Questionnaire

Form H-38 Uninsured Employer – Employer Questionnaire

Form H-10 Application for Lump Sum

Form C-50R Stipulation for Advancement

Form C-3 Claim Amendment

Form H-11-AOA Cover Sheet for Action on Claims on Appeal

Death Claims

Form C-35 Dependent’s Claim for Death Benefits

Form C-18 Certification of Funeral Benefits

Form C-19 Claim for Funeral Benefits Only

Address or Information Changes

Form H-31R Claimant’s Request for Change of Address

Form H-22R Employer or Self-Insured Employer Request for Change of Address

Form H-13R Insurer Request for Change of Address

Form H-23R Request for Employer Designee to Receive Notice of Employee Claims

Other Filing

Form H-35R Request for a Hearing for Referral to Maryland Insurance Fraud Division

Form C-51 Claim for Medical Services

Form VR-6 Agreement on the Propriety of Services and Selection of Practitioner

Subpoena & Medical Release

Form H-08 Subpoena/Subpoena Duces Tecum

Form H-08/OTS Objection to Subpoena of Medical Records

Settlement

Form H-44 Claimant’s Consent to Pay Attorney and Doctor Fees

Form H-34 Stipulation of Parties and Award of Compensation

Form H-07 Settlement Worksheet

Form H-05 Claimant’s Affidavit in Support of Settlement

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