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Client Forms
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Additional Client FormsFor your convenience, we have posted some of our forms on the website. Click the link below to open, download, and print the needed document.
PERSONAL INJURY FORMS- Authorization to Release Medical Information (HIPAA)
- Application for No-Fault Benefits (PIP) 3 pages
- Wage and Salary Verification (for earnings before accident)
- Mileage Claim Reimbursement
- MEDICARE Information Authorization
- Attestation Form for Petition for Benefits
- Authorization to Release Medical Information (HIPAA)
- Wage Statement for Pre-Accident Earnings
- Mileage Claim Reimbursement
- Statement of Charges for Drugs and Medical Supplies Reimbursement
- Social Security Consent for Release of Information
- Defense Base/Longshore & Harbor Workers’ Retainer Packet (14 pages)
- Authorization to Release Medical Information
- Report of Earnings LS-200
- Notice of Employee’s Injury or Death LS-201
- Employer’s First Report of Injury or Occupational Illness LS-202
- Employee’s Claim for Compensation LS-203
- Claim for Death Benefits LS-262
