Louisiana Workers' Compensation Forms

Louisiana Workers' Compensation Forms - LWCC offers you several quick easy ways to report claims We will take care of the filing requirements and deadlines with state or federal agencies on your behalf Ways to report a claim Online interactive lwcc The fastest way to report your claim is through LWCC s password protected website LWCC Interactive

Form ENG ESP Longshore Mileage Reimbursement Form Form ENG ESP Longshore Consent for Release of Payroll Information Form Form ENG ESP Longshore Choice of Physician Form Form ENG ESP Employee s Monthly Report of earnings LDOL Form 1020 Form ENG ESP Injured Worker First Fill Prescription Form

Louisiana Workers' Compensation Forms

Louisiana Workers' Compensation Forms

workers compensation - first report of injury or illness. employer (name & address incl zip) carrier/administrator claim number osha log number report purpose code jurisdiction jurisdiction claim number insured report number employer's location address (if different) location # industry code employer fein phone #

7 10 2023 Mileage reimbursement of 655 cents per mile is effective July 1 2023 per LA R S 23 1203 D NOTICE 3 23 2020 Please see LWC COVID 19 Updates for important bulletins regarding WC changes while the Governor s Stay at Home Order is in effect NOTICE 3 29 2018

Workers Comp Claim Forms Filing Workers Comp Claims LWCC

1001 N 23rd Street Baton Rouge LA 70804 9040 1 800 201 3457 toll free or 225 342 7565 This page provides information regarding Workers Compensation Unemployment Insurance Workforce Development Minors and Apprentices and Licensing for Businesses

Fill Free Fillable Louisiana Workers Compensation Corporation PDF Forms

LWCC is a private nonprofit mutual insurance company and the largest workers compensation carrier in Louisiana

LWCC Claims Workers Comp Claims Process

Second Injury Board Meeting Agenda Notice of Claim with the Second Injury Board PDF Form B P I Form PDF Second Injury Board Rules PDF Second Injury Fund EFT Enrollment Form Note Please contact the OSRAP helpdesk at 225 342 1097 for EFT Enrollment Form assistance Settlement Evaluation PDF

Top 16 Louisiana Workers Compensation Forms And Templates Free To Download In PDF Format

OFFICE OF WORKERS COMPENSATION POST OFFICE BOX 94040 BATON ROUGE LA 70804 9040 For information call 225 342 7565 or Toll Free 800 201 3457 Docket Number Social Security No Date of Injury Illness Part s of Body Injured Date of This Request Date of Hire Date of Birth DISPUTED CLAIM FOR COMPENSATION 7

‍ If you prefer to fill out the Louisiana Workforce Commission's Office of Workers' Compensation's First Report of Injury or Illness (Form LWC-WC-IA-1), you may fax the report to LWCC. You may no longer submit this form to the Office of Workers' Compensation.

Span Class Result Type

Rights And Responsibilities in Workers Compensation for employees and employers relating to Louisiana s workers compensation entitlement and procedures Workers compensation Stop Payment Form 1003 54 KB LWC WC 1003 Form is sent by the Employer Insurer to the injured workers and OWCA Strategic Plan July 1 2023 June 30

Louisiana Workers' Compensation Forms

OFFICE OF WORKERS COMPENSATION POST OFFICE BOX 94040 BATON ROUGE LA 70804 9040 For information call 225 342 7565 or Toll Free 800 201 3457 Docket Number Social Security No Date of Injury Illness Part s of Body Injured Date of This Request Date of Hire Date of Birth DISPUTED CLAIM FOR COMPENSATION 7

Form ENG ESP Longshore Mileage Reimbursement Form Form ENG ESP Longshore Consent for Release of Payroll Information Form Form ENG ESP Longshore Choice of Physician Form Form ENG ESP Employee s Monthly Report of earnings LDOL Form 1020 Form ENG ESP Injured Worker First Fill Prescription Form

Louisiana Workers Comp Forms Workers Compensation LLC