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Links To Workers Compensation Forms, Pages, and Info

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  • Primary Treating Physician Reports -

    PR2 - Primary Treating Physicians Progress Report
    PR3 - Primary Treating Physicians Permanent and Stationary Report (1997 Permanent disability rating schedule)
    PR4 - Primary Treating Physicians Permanent and Stationary Report (2005 Permanent disability rating schedule)
    Form 5020 - Employer's Report of Occupational Injury or Illness
    Form 5021 - Doctor's First Report of Occupational Injury or Illness
    DWC Form 280 - Petition for Change of Primary Treating Physician

  • Vocational Rehabilitation Forms -

    RU 90 Treating Physician Report of Disability
    RU 91 Description of Job Duties
    RU 94 Notice of Offer of Modified or Alternate Work
    RU 102 Rehabilitation Plan
    RU 103 Request for Dispute Resolution
    RB 105 Request for Conclusion
    RU 105 Notice of Termination
    RB 107 Declination for Date Of Injury's pre 1/1/90
    RU 107 Declination for Date Of Injury's 1/1/90 - 12/31/93
    RU 107A Declination for Date Of Injury's post 1/1/94
    RU 120 Evaluation Summary
    RU 121 Program Report
    RU 122 Settlement of Prospective Vocational Rehabilitation Services
  • Copyright Law Offices of Jim Nagel 2007