Mark Adams is now of counsel to NR&S

Download the C-23 Change of Physician form here

This form will allow you to change doctors.

Download the C-60 Travel Expenses form here

This form is used whenever the BWC or your employer requires you to attend an examination. You can be reimbursed for travel expenses such as mileage, parking, and other incidental costs.

Download the C-77 Change of Address form here

This form should be used if you change your residence. (You should also call us to let us know.)

Download the C-84 Request for Temporary Total form here

You will need to complete the section entitled "To Be Completed By Injured Worker." Your doctor will complete the section entitled "To Be Completed By Physician of Record."

Download the C-101 Medical Release form here

This is the only medical release form that you are required to complete for either the BWC or your employer. Check with us before providing this to anyone.

Download the C-140 Wage Loss Application form here

This form will be used to apply for a wage loss benefit when you become eligible.

Download the C-141 Job Search form here

This form must be filed with your C-140 form for wage loss eligibility. You must complete all information for each job search you make.

Download the C-230 Authorization To Receive Check form here

This form will allow us to process your benefits.

Download the FROI First Report of Injury form here

This is the form on which you report your injury to your employer and/or the BWC.

Download the R-2 Authorization of Representation form here

This form allows us to be your authorized representative.