Modification
& Disbursement of Benefits
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Form
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Description
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Petition
to Modify, Terminate, or Suspend Compensation Form #WC54
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This
form is used by an insurer to request that the director modify,
terminate, or suspend a claimant's temporary disability benefits based
on information outlined in the petition. |
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Objection
to Petition to Modify, Terminate, or Suspend Compensation
Form
#WC55
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This form is used by the claimant to
object to the proposed modification, termination, or suspension of workers’
compensation benefits by the Director. |
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Petition
to Reopen
Form
# WC37
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This form is used by the claimant to request that a workers’
compensation claim be reopened. |
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Request For Lump Sum Payment Form # WC62
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Page 1 of this form is used by the
claimant to request that permanent disability benefits be paid in a lump
sum. Page 2 of the form is used by the insurer to provide proof to
the Division of accurate calculation and timely payment of benefits in a
lump sum. |
