Cover Sheet and Welcome Letter
Table of Contents
Instructions for Posters
Insurance Fraud Leaves a Paper Trail Poster
Insurance Fraud Makes Me Croak Poster
Fraud Prevention Poster (Versión en Español)
Instructions for Injury Reports
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)
Choosing a Doctor for a Work-Related Injury – Rule 50 (Versión en Español)
NWCC Form 50 – Employees Choice or Change of Doctor (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
NE Workers’ Compensation Court Information Sheet – NE Workers’ Compensation (Versión en Español)
Instructions for General Forms
Request for Subrogation Waiver
Form ERM-14 – Confidential Request for Ownership Information
Company Contacts Verification
