Audit
- Audit Worksheet Release Form
- Independent Contractor Questionnaire
- Independent Contractor Questionnaire (Spanish)
- Independent Contractor Affidavit
- Premium Audit Revision Request
Claims
- IA-1 First Report of Injury
- Direct Deposit
- Direct Deposit (Spanish)
- Average Weekly Wage Certification (AWW)
- Medical Waiver & Consent Form (Form 106)
- Notice of Designated Physician (Form 113)
- Injured Worker Reimbursement Form (Form 114)
- Job Analysis Form
- W-9 Taxpayer Identification Number Request Form (IRS Website)
Other
Underwriting
- ACORD Agent/Broker of Record Change
- Aviation Questionnaire
- Employee Leasing Company Registration Form (EL-1)
- ERM-14
- Coal Mine Census
- Coal Mine Questionnaire
- KEMI Direct Business Questionnaire
- Lessee Information Form (EL-2)
- Logging Questionnaire
- No Loss Certification
- Owner / Operator Supplemental Information Form
- Policy Cancellation Request Form
- Sawmill Supplemental Application
- Temporary Staffing / Employee Leasing Client Information Form
- Temporary Staffing / Employee Leasing Supplemental Application
- Workers’ Compensation Experience Rating for Self-Insureds (ERM-6) with Instructions