Flat File Transmission of Claim Information
List of Claim Forms Available for Flat File Transmission
| Form ID |
Form Title |
| C-2 |
Employer's Report of Work-Related Injury/Illness |
| C-7 |
Notice that Right to Compensation is Controverted |
| C-11 |
Employer's Report of Injured Employee's Change in Status or Return to Work |
| C-240 |
Employer's Statement of Wage Earnings |
| C-669 |
Notice to Chair of Carrier's Action on Claim for Benefits |
| C-8/8.6 |
Notice that Payment of Compensation Has Been Stopped or Modified |
| C-8.1 |
Notice of Treatment Issue(s)/Disputed Bill Issue(s) |
| DB-470 |
Preliminary/Final Claim for Reimbursement of Benefits Paid Under Disability Benefits Law |
| RFA-1 |
Claimant's Request for Further Action |
| RFA-2 |
Carrier's/Employer's Request for Further Action |
| VF-2 |
Political Subdivision's Report of Injury to Volunteer Firefighter |
| VAW-2 |
Political Subdivision's Report of Injury to Volunteer Ambulance Worker |
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