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Louisiana Administrative Code

Chapter 67

Forms

State of Louisiana

6701Annual Report of Workers' Compensation Costs; Form LW-WC-1000 6703Notice of Payment, Modification, Suspension, Termination or Controversion of Compensation or Medical Benefits; Form LW-WC-1002 6705Stop Payment Form; Form LW-WC-1003 6707Request for Social Security Benefits Information; Form LW-WC-1004 6709Motion for Recognition of Right to Social Security Offset; Form LW-WC-1005A 6711Order Recognizing Right to Social Security Offset; Form LW-WC-1005B 6713Subpoena for Deposition and Subpoena Deuces Tecum; Form LW-WC-1006A 6715Subpoena Deuces Tecum for Inspection; Form LW-WC-1006B 6717Subpoena and Subpoena Deuces Tecum; Form LW-WC-1006C 6719Employer’s Report of Injury/Illness; Form LW-WC-IA-1 6721Disputed Claim for Compensation; Form LW-WC-1008 6725Request for Compromise and Lump Sum Settlement; Form LW-WC-1011 6727Request for Independent Medical Examination; Form LW-WC-1015 6729Employee's Monthly Report of Earnings; Form LW-WC-1020 6731Employee Certificate of Compliance; Form LW-WC-1025EE 6733Employer Certificate of Compliance; Form LW-WC-1025ER 6737Attorney Fee Notice of Lien; Form LW-WC-1027 6739Scheduling Order; Form LW-WC-1028 6741Choice of Physician; Form LW-WC-1121 6743Workers’ Compensation Records Request Form; LW-WC-1150 6745Employee Authorization for OWCA to Release Confidential Workers’ Compensation Records; LW-WC-1151 6747Request for Waiver of Payment of Advance Costs Form; LW-WC-1160 6749Form for Judges to Report Contempt Findings