Insurance Forms
PDF File: 1 page; Last revised October 1, 2021
Notice of Intention to Reduce or Discontinue Payments
The Form 36 is to be completed by the respondent (employer/workers’ compensation insurance carrier) to notify the Workers’ Compensation Commissioner, the claimant (employee/decedent), and all parties to the claim of its intention to reduce or discontinue payment of the claimant’s workers’ compensation benefits.
PDF File: 1 page; Last revised July 13, 2009
Order to Second Injury Fund in Cases of Concurrent Employment
The Form 44 is to be completed by a workers’ compensation insurance carrier seeking reimbursement from the state Second Injury Fund. Once both the carrier and the Fund agree on the figures and sign the form, it is sent to the Commission for approval.
[NOTE: Read Memorandum No. 2004-04 for complete instructions regarding the filing of this form.]
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