Workers' Compensation Claims Kit
Note: You will need a username and password to access these forms. If you don't already have the username and password, contact Dara Overholt at 310-212-0363 x3730 or via email: doverholt@keenanassoc.com
You
will need Adobe Acrobat Reader to view and print the forms. If you do
not have it, click
here.
| Briefing - Personal Physician Predesignations March 2006 | ||
| WC Benefits Summary (revised 4/08) | ||
| Posting Notice (revised 6/04) | ||
| New Hire Pamphlet (revised 10/06) | ||
| Personal Physician Request and Ackowledgement
Form (New Hire Pamphlet attachment - revised 10/06) |
||
 Notice
of Personal Chiropractor or Personal Acupuncturist Form |
||
| DWC-1 Claim Form (State version 8/04) | ||
| Notice of Potential Eligibility/DWC-1 (State version 8/04) | ||
| Claims Kit Order Form (revised 10/06) | ||
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