Worker's Compensation

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Contact the Hamilton County Workers' Compensation Specialist
Contact your Departmental Workers' Comp Liaison
Bureau forms are available by contacting your Bureau representative or CompManagement Health Systems claims specialist.

Employee Initiated Forms

HamCo044 - First Report of an Injury, Occupational Disease or Death FROI-1 Bureau form 1101		Completed by an employee to report a work related incident whether or not medical attention is sought

HamCo047 - Authorization to Release Medical Information Bureau form C-101		Completed by an employee reporting an incident allowing retrieval of claim related medical documents

HamCo048 - Salary Continuation Bureau form C-55e		Completed by an employee reporting an incident providing mandatory information regarding payment of wages

HamCo049 - Physicians Report of Work Ability Bureau form Medco-14		Completed by each treating physician and required for an employee to return to work

Supervisor Initiated Forms

HamCo045 - Hamilton County Supervisor Investigation Form		Completed by the acting supervisor on duty at the time of an incident whether or not medical attention is sought

HamCo046 - Hamilton County Statement of Witness to the Incident Form		Completed by any and all witnesses to an incident reported by an employee whether or not medical attention is sought

BUREAU FORMS (Most commonly used by employees):

C-84: Request for Temporary Total Compensation: used by the employee to request compensation from the Bureau

C-86: Motion: used by the employee to request additional allowances be added to an allowed claim

C-94A: Wage Statement: Used to report wages to the Bureau