Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
WC-BOR – Bill of Rights for the Injured Worker (Versión en Español)
WC-P1 – Panel of Physicians (Versión en Español)
WC-P3 – WC/MCO Panel (Versión en Español)
Stop Workers’ Compensation Fraud and Insurance Non-Compliance (Versión en Español)
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
WC-1 – Employer’s First Report of Injury (Versión en Español)
WC-6 – Wage Statement
Incident Investigation Report (Versión en Español)
Supervisor’s Report of Employee Incident (Versión en Español)
Witness Statement of Injury or Incident (Versión en Español)
Instructions for Injured Worker Handouts
Injured Workers First Fill Prescription Form (Versión en Español)
Panel Acknowledgement and Physician Selection (Versión en Español)
WC-207 – Authorization and Consent to Release Information (Versión en Español)
Consent and Authorization for Release of Information Form (Versión en Español)
Request for Medical History Form (Versión en Español)
Direct Deposit Authorization Form (Versión en Español)
Instructions for Informational Documents
Omaha National Contact Information
Reduce Your Workers Compensation Costs
Provider Panel Information for Employers
Best Practices: Role of the Employer
Best Practices: Early Return-to-Work Program
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
Instructions for State-Specific Forms & Documents
WC-10 – Notice of Election or Rejection of Workers’ Compensation Coverage
