Applications:

State Insurance Fund application:
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Policy Services Forms:

Waiver of Subrogation requests
Requests for waiver of subrogation policy endorsements must include all the information on this form, but must be on the insured's letterhead. After they are received by our office (email to Allison Dato adato@hamondgroup.com they have to be endorsed on to the policy by the Group underwriter before a certificate can be issued. This can take a minimum of a few days up to and over a week or more so please send in the waiver requests as early as possible.
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Claims Related Forms:

NOTICE TO ALL EMPLOYERS:
Employers Report of Work-Related Accident (C-2):

Please be advised that the Workers’ Compensation Board has revised the Employer’s Report of a Work Related Injury/Illness form, aka C-2. The revision of this form is to develop a more “user-friendly” format to collect additional information needed for quick processing and to better address questionable claims.

As of 1/1/09 this new C-2 form will be the only version recognized by the WCB for claims arising out of and in the course of employment.

As always forward your completed C-2 to our office. We will then review the C-2 and if no corrections or changes are required we will forward the form to the State Insurance Fund. We will then begin the tracking and monitoring process.
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In accordance with the Workers’ Compensation Board Rule 300.37 (Claimant Information Packet)

The employer is also now required to distribute a "Claimant Information Packet" to workers at the time of their injury or illness.

Employers can comply with Board Rule 300.37 by distributing the "Packet" to their workers when they become aware of any injury or work-related illness. Please note that the filing of the C-3 form (by the injured employee) found within this "Packet" is not mandatory.

Employers can download, print and distribute this version of the Packet as needed.
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Employers Report of Change in Employment Status (C-11):
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Employers Statement of Wage Earnings (C-240):
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Employer's Request for Reimbursement (C-107):
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