Member Forms
Now available for your convenience, are printable PDFs of the
forms we send to our members when additional information is needed in the
claims adjudication process. These information requests pertain to obtaining
either pre-treatment history, other insurance carrier coverage or we are
attempting to determine if services rendered were work related.
Member Forms
The forms can be accessed by clicking on the
appropriate form title below.
Once the form opens, it can be printed, completed and mailed in to the address
specified on the form.