Special Resources » Forms: Insurance


Download a large number of workers compensation forms. Sample bid package - forms, checklists, etc. used by a university's risk management department. Series of risk management forms and letters. Forms for life & health, property casualty, WC insurance, etc.

The following is the collection of special resources throughout the library. Click on main category / sub-category for that section of the library OR Click on resource title for immediate access to the resource.
Claims Management » Claims Filing
P-C insurance claims checklists, interview statement guides, etc

Property Claims Checklist [pdf] [19357] ?

The following is a checklist of steps to take in the event of loss

Claims Management » Property Claims
Property insurance claims management materials

Property Loss Report [14519] ?

Forms assist with reporting property losses

Claims Management » Return to Work
Managing workers compensation costs by returning injured workers to work

Chapter 5 Return to Work Program [9428] ?

Full text of WC return to work program for state agencies in Texas - plus, checklist & forms

GA-Georgia Return to Work Program [19674] ?

An explanation of the state of Georgia's RTW program for state employees

Implementing a Job Task Bank [pdf] [25367] ?

Steps for creating a list of duties that can be offered to an injured worker who is returning to work

MN-Minnesota Injured Workers Responsibilities [18392] ?

A sample policy statement to be signed by the injured worker

Reasonable Accommodation Checklist [pdf] [35937] ?

Steps to take for accommodating an injured employee's return to work

Sample Early Return to Work Forms [25604] ?

A series of templates for Return to Work

Transitional Work Plan for Returning to Work [35938] ?

A form for use in outlining the plan specifications for returning an injured employee to work

Claims Management » WC Forms
Download state workers compensation forms such as first report of injury

AK-Alaska - Workers Compensation Forms [6243] ?

Download Alaska workers compensation forms, first report of injury and more

AR-Arkansas - Workers Compensation Forms [1568] ?

Nearly 20 different workers compensation forms for the state of Arkansas may be downloaded

AZ-Arizona - Workers Compensation Forms [10615] ?

Workers comp forms, self-insured forms, ADOSH forms and more

CA-California - Self-insured WC Forms [4957] ?

Download workers compensation forms for the state of California self-insureds

CA-California - Workers Compensation Forms [10303] ?

WC forms for the state of California

CT-Connecticut - Workers Compensation Forms [3541] ?

Large number of forms from the Connecticut Workers Compensation Commission

FL-Florida - Workers Compensation Forms [4959] ?

Download the commonly used workers compensation forms for Florida

GA-Georgia - Workers Compensation Forms [6267] ?

Download workers compensation forms for the state of Georgia

GA-Georgia Subsequent Injury Trust Fund Claim Forms [20036] ?

Also provides statutory filing requirements

HI-Hawaii WC Forms [32892] ?

Download workers compensation forms for the State of Hawaii

IA-Iowa - Workers Compensation Forms [10091] ?

Workers comp publications for the state of Iowa

ID-Idaho - Workers Compensation Forms Used by the Industrial Commission [6251] ?

Download WC forms for the state of Idaho

IN-Indiana - Workers Compensation Forms [6255] ?

Download WC forms for the state for Indiana

KS-Kansas - Workers Compensation Forms [3903] ?

Download a large number of WC forms for the state of Kansas

KS-Kansas Self Insurance Application [pdf] [11205] ?

Download Kansas WC self-insurance application form

KY-Kentucky - Workers Compensation Forms [4966] ?

Download forms used for workers compensation in Kentucky

LA-Louisiana - Workers Compensation Forms & Instructions [7972] ?

Download WC forms for the state of Louisiana

MA-Massachusetts - Workers Compensation Forms [6259] ?

Download WC forms for the state of Massachusetts

MD-Maryland - Workers Compensation Forms [13522] ?

Some forms available for downloading

ME-Maine - Workers Compensation Forms [6262] ?

Download selected WC forms for the state of Maine

MI-Michigan - Workers Compensation Forms [5788] ?

Download WC forms, including the Employers Basic Report of Injury

MN-Minnesota - Workers Compensation Forms [4169] ?

Download the Minnesota WC forms

MO-Missouri - Workers Compensation Forms [10080] ?

Download frequently used workers compensation forms

MT-Montana - Workers Compensation Court Forms [10092] ?

Download legal forms for the Workers Compensation Court of Montana

NC-North Carolina - Workers Compensation Forms [4986] ?

Download forms required for workers compensation in North Carolina

ND-North Dakota Workers Compensation Forms [15317] ?

WC related forms for North Dakota

NE-Nebraska: Workers Compensation Forms [3020] ?

Download forms related to workers compensation in Nebraska

NJ-New Jersey - Workers Compensation Forms & Brochures [6286] ?

Download workers compensation forms for the state of New Jersey

NM-New Mexico - Workers Compensation Forms [6288] ?

Download workers compensation forms for the state of New Mexico

Updated NV-Nevada - Workers Compensation Forms [6290] ?

Download workers compensation forms for Minnesota

NY-New York - Workers Compensation Forms [4979] ?

Download commonly used forms required for WC in the state of New York

NY-New York Independent Medical Examination (IME) Forms [15221] ?

Download IME forms for the state of New York

OH-Ohio - Workers Compensation Forms [4989] ?

Download Ohio's BWC forms

OH-Ohio Industrial Commission Forms [659] ?

Download the forms for WC for the state of Ohio

OR-Oregon - Workers Compensation Forms [4984] ?

Download a very large number of workers compensation forms for Oregon

RI-Rhode Island - Workers Compensation Forms [16124] ?

Download WC forms for the State of Rhode Island

SC-South Carolina Workers Compensation Forms [23170] ?

Download a series of workers compensation forms for the state of South Carolina

SD-South Dakota - Workers Compensation Forms [13521] ?

Download WC forms including First Report of Injury for South Dakota

TN-Tennessee WC Forms [14401] ?

Download a series of workers compensation forms for the state of Tennessee

TX-Texas - WC Forms [4995] ?

List of workers compensation forms and brochures

US Division of Coal Mine Workers' Compensation Forms - Black Lung [29025] ?

OWCP forms for federal workers to apply for workers compensation benefits under Black Lung benefits

US Division of Energy Employees Occupational Illness Compensation Claims Forms [29026] ?

Claims forms for benefits under the Energy Employees Occupational Illness Compensation Program Act

US Division of Federal Employees Compensation Forms [29023] ?

OWCP forms for federal workers to apply for workers compensation benefits

US Division of Longshore and Harbor Workers' Compensation Forms [29024] ?

OWCP forms for federal workers to apply for workers compensation benefits under Longshore benefits

UT-Utah Workers Compensation Forms [23225] ?

Download a variety of WC forms for the State of Utah

VA-Virginia - Workers Compensation Commission Forms [13084] ?

WC forms for the state of Virginia

VT-Vermont - Workers Compensation Forms [5001] ?

Download workers compensation forms

WI-Wisconsin - Workers Compensation Forms [4803] ?

Access a variety of forms (e.g., first report of injury) related to workers compensation

WV-West Virginia - Workers Compensation Forms [4782] ?

The following forms are approved for use in West Virginia workers compensation claims

WY-Wyoming - Workers Compensation Forms [16123] ?

Download WC forms for the state of Wyoming

Fleet » Age
Driving tips for senior drivers and teenagers

Family Driving Agreement - Elderly [pdf] [18319] ?

With this document, the driver designates a trusted relative or friend to notify him when he should stop driving

Health » CMS
Medicare information for the healthcare industry - directories, fees, contracts,

Medicare Provider Technical Information [7829] ?

Information for physicians, health care professionals, researchers, etc.

Health » Medicare
Beneficiary and consumer info

Basics: Medicare - Certificates of Medical Necessity [22258] ?

Forms for wheelchairs, hospital beds, infusion pumps, etc

Human Resources » Volunteers
Articles, sample policies and agreements related to volunteer management

Volunteer Injury Coverages [15781] ?

Full text of a risk management policy in use by state agencies in Oregon - includes forms

Risk Mgt » Checklists
Checklists for risk managers

Business Owners Insurance Checklist [24084] ?

ill make it easier to talk to your agent about what insurance you need.

Checklist For Insurance Carrier Loss Control Services [4804] ?

Checklist designed to help you evaluate your insurance carrier's safety services

Flood Insurance Checklist [34317] ?

To be used for insurance coverage and risk management analysis

Insurance Claim Checklist [35165] ?

Gather the information claim representatives are most likely to need when a claim is reported

ISO Commercial Property Classification Checklist [26505] ?

A checklist for classifying property ownership

Property Values Checklist [pdf] [34319] ?

To be used for insurance coverage and risk management analysis

Risk Mgt » Construction
Risk management and insurance related issues in the construction industry

Construction Defect Claims Mitigation [11644] ?

Keys to Preventing Construction Defect Claims

Risk Mgt » Cyberliability
Insurance coverage issues for internet liability

Website Risk Management [35702] ?

Reducing liability risk

Risk Mgt » EPL
Employers Professional Liability (EPL) insurance

Employment Practices Risk Management Audit [9621] ?

Self audit related to hiring practices, terminations, etc.

Risk Mgt » Forms
Library of forms used by the risk management department, sample RFPs

Risk Management Forms [26074] ?

A series of checklists and forms in use at a major university

Australia: Risk & Insurance Audit Checklist [pdf] [37926] ?

Includes major lines of insurance coverage

CA-California Sample Letter For Downrating [pdf] [30023] ?

A sample form letter for clients

CA-California Sample Letter For Insurance Carrier Rehabilitation [30025] ?

A sample form letter for clients from insurance agents/brokers

CA-California Sample Letter For Insurer Insolvency [30024] ?

A sample form letter for clients from insurance agents/brokers

CA-California Standard Broker Fee Agreement [30026] ?

Text of the regulations with a sample broker fee disclosure form

CA-California Standard Broker Fee Disclosure & Fee Agreement [27887] ?

Summary of the state regulations and sample standard forms

CA-California University Risk Management Forms [14039] ?

Insurance & liability forms in use by a major university

Case Management Techniques for Major Fire Losses [23626] ?

Checklist provides a snapshot into the many action items that must be faced on a major claim

Claims Forms Center [19377] ?

Claims letters and forms

Claims Reviews - Guiding Principles [pdf] [27254] ?

Checklist for a reinsurance claims review

Equipment Lease Agreement and Guide [pdf] [12203] ?

Sample contract language for use in leasing agreements

Example Security Incident Form [pdf] [16591] ?

Security incident report form example

Exposure Reporting Manual [23422] ?

Rating basis by line of coverage - includes instructions and forms

Facilities Use Hold Harmless Agreement & Insurance Requirements [pdf] [27931] ?

Example of the guidelines/form used by the State of Idaho for state owned buildings

General Incident Report [pdf] [26072] ?

(Documents and describes any type of personal injury or property damage incurred by non-employees

Insurance Claims Checklists [23619] ?

A variety of checklists related to filing insurance claims

Loss Control Program Audit Checklist [35940] ?

A sample program audit checklist used by a state to evaluate their state agency loss control programs

Medical Claims Audit of Third Party Administrators [27553] ?

A sample audit with focus on self-insured medical plan and prescription drug plan

Notice of Claim Form [pdf] [7934] ?

For claims related to injury to person or damage to personal property presented to a county government

Personal Property Inventory Form [pdf] [23823] ?

Designed for homeowners

Property/Liability Forms [15598] ?

Includes risk management forms as well as the full text of the manual

Release of All Claims Form [pdf] [27551] ?

A sample form in use at a major university

RFP - Broker, Risk Management, TPA [pdf] [15689] ?

Text of a sample RFP for an insurance broker, risk management and TPA claims services

RFP - Workers Compensation Claims Administration [pdf] [15688] ?

Full text of a sample RFP used by a state for TPA services

Risk & Insurance Audit Checklist [pdf] [26077] ?

Checklist for conducting an insurance risk management program audit

Risk Management Division Forms [15791] ?

Sample forms to be used in a risk management program

Risk Management Forms Library [14025] ?

Series of risk management forms - public entities

Self-Insurance Audit Checklist for WC [pdf] [26078] ?

For the State of Washington

Summary of Benefits and Coverage (SBC) Template [doc] [27554] ?

For compliance with Affordable Care Act Implementation

Various Risk Management Forms [19368] ?

View a variety of risk management forms in use by a California university

WA-Washington WC Claims Checklists [26073] ?

For used by self-insureds

WI-Wisconsin Risk Management Forms [14516] ?

Full text of risk management forms in use by a major university

Risk Mgt » Hold Harmless
Hold harmless agreements

Procedures Manual for Insurance Requirements in Contracts [15570] ?

Full text of a hold harmless agreement and insurance contract requirements used by a state agency

Risk Mgt » Industries
Risk management advice for specific industries

Public Entity Loss Control Manual [24830] ?

A manual for municipalities, county governments, state agencies, etc.

Risk Mgt » OCIP
Owner Controlled Insurance Programs (OCIP), construction wrap up materials

OCIP Forms [19519] ?

OCIP/Wrap-up forms

University OCIP Manual [19522] ?

In use by a major US university

Risk Mgt » Product Liability
Product assurance manual, consumer product safety, etc.

Checklist - Product Liability Complaint and Claim Handling [pdf] [36760] ?

To evaluate elements of a product liability risk control program related to product complaints and insurance claims

Checklist - Product Liability Design [pdf] [36756] ?

To evaluate elements of a product liability risk control program related to the design process

Checklist - Product Liability for Manufacturers [pdf] [36755] ?

A series of yes/no questions to evaluate elements of a product liability risk control program for manufacturers

Checklist - Product Liability Manufacturing and Distribution Process [pdf] [36761] ?

To evaluate elements of a product liability risk control program related to the manufacturing and distribution stages

Checklist - Product Liability Sales and Advertising [pdf] [36758] ?

To evaluate elements of a product liability risk control program related to sales and advertising

Checklist - Product Recall Planning [pdf] [36759] ?

To evaluate elements of a product liability risk control program related to product recall planning

Checklist - Product Recall Preparedness [pdf] [36757] ?

To evaluate elements of a product liability risk control program related to the product recall process

CPSC Product Recall Handbook [pdf] [36754] ?

For those that manufacture, import, distribute, retail or sell consumer products

Risk Mgt » Programs
Full text of risk management policy and procedure manuals

GA-Georgia Comprehensive Loss Control Program [35941] ?

This program helps state agencies develop a Risk Management culture to increase safety awareness and reduce claims

ID-Idaho Safety and Loss Control Program Model [pdf] [16734] ?

Recommended elements of a safety and loss control program for state agencies - forms, checklists

Property & Liability Manual [pdf] [14524] ?

Full text of a manual in use by a state government

Risk Mgt » Property
Property insurance and risk management

Annual Property Reevaluation and Renewal [16679] ?

Property valuation forms and procedures

Property Loss Preparedness Checklist [pdf] [19358] ?

The following is a checklist that should help determine your loss preparedness

Risk Mgt » Risk Management Dept
Home pages of risk management departments

CT-Connecticut State Insurance Risk Management Board [19675] ?

Serving Insurance and Risk Management Needs of Connecticut State Agencies, Colleges, Universities

Safety Mgt » Accidents
Accident investigation programs, job safey analyses, etc.

Incident Investigation Basics [23670] ?

Includes a sample WC accident investigation report form

Safety Mgt » Forms
Forms used by safety departments

School Incident Report Form [22629] ?

School Violent Incident Reporting Instructions

State Government » AK-Alaska
US state agencies, laws and regulations for the state of Alaska

Self Insurance: Alaska Employer Guidance for WC Self Insurance [11151] ?

Series of documents, forms, etc. related to self-insurance in the State of Alaska

State Government » AZ-Arizona
Access to state agencies and laws for the state of Arizona

Self Insured Employers WC Forms [23181] ?

Download WC forms for self-insured employers in the State of Arizona

State Government » CT-Connecticut
Access to state agencies and laws for the state of Connecticut

Self Insurance: Connecticut: Employer Self-Insurance Application Package [pdf] [11201] ?

Information package for employers wishing to self-insure their WC liabilities - includes forms

State Government » IN-Indiana
Access to state agencies and laws for the state of Indiana

Self Insurance: Indiana Self Insurance Resources [11204] ?

Resources for Indiana WC self-insurance

State Government » LA-Louisiana
Access to state agencies and laws for the state of Louisiana

Self-Insurer WC Application - Louisiana [23188] ?

Download the application to become self-insured for WC in LA

State Government » MO-Missouri
Access to state agencies and laws for the state of Missouri

Missouri WC Self-Insurance Program [15295] ?

Information and forms for the Missouri self-insurance program for WC

State Government » NH-New Hampshire
Access to state agencies and laws for the state of New Hampshire

Self Insurance: New Hampshire Self Insurance for WC [11233] ?

Requirements for the State of New Hampshire

State Government » NY-New York
Access to state agencies and laws for the state of New York

Self Insurance Information - New York WC [5012] ?

Information for self insuring for workers compensation in the State of New York

State Government » OH-Ohio
Access to state agencies and laws for the state of Ohio

Ohio WC Self-Insurance Program [5311] ?

Description of the program options

State Government » WI-Wisconsin
Access to state agencies and laws for the state of Wisconsin

Plain Language Summary of Law Changes [20929] ?

A brief summary of legislative changes to the Worker’s Compensation Act

State Government » WV-West Virginia
Access to state agencies and laws for the state of West Virginia

West Virginia WC Self-Insurance Program [11270] ?

Download forms, checklists and general information about self-insurance in West Virginia

Workers Comp » Federal Laws
Federal workers compensation laws

Workers Comp » WC Programs
Support materials for implementation of workers compensation programs

NV-Nevada Risk Management Program [15585] ?

Forms, program materials, checklists for state agencies in Nevada

Workers Compensation Audit Checklist [pdf] [1529] ?

Sample audit form

Workers Compensation Program [8311] ?

A university's workers compensation program



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