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FLORIDA CLAIMS KIT

• Complete Florida Policyholder's Guide to a Policy To Do More 
• WECARE Managed Care Program
• Drug-Free Workplace Programs
• Safety Management
• Workplace Safety Program
• Accident/Injury Reporting
• Accident/Injury Investigation
• Fraud Prevention
• Staying Informed About Your Workers' Compensation Program

GEORGIA CLAIMS KIT

• Complete Georgia Policyholder's Guide to a Policy To Do More 
• WECARE Managed Care Program
• Drug-Free Workplace Programs

• Safety Management
• Workplace Safety Program
• Accident/Injury Reporting
• Accident/Injury Investigation
• Fraud Prevention
• Staying Informed About Your Workers' Compensation Program

CLAIMS FORMS - Fax to FHM at 1-407-352-5788

• Florida First Report of Injury      login 
• Georgia First Report of Injury    login 
• Alabama First Report of Injury login
• South Carolina First Report of Injury login
• North Carolina First Report of Injury login
• Florida Wage Statement 
• North Carolina Wage Statement 
• South Carolina Wage Statement 
• North Carolina Return To Work Form

ROCKPORT PROVIDER DIRECTORY FOR FLORIDA

COVENTRY PROVIDER DIRECTORY FOR ALABAMA, GEORGIA, NORTH CAROLINA & SOUTH CAROLINA

CLAIMS MANAGEMENT FORMS

• Claim Reporting Guide
• Georgia Bill of Rights for the Injured Worker

                      English    Spanish

• Georgia Panel of Physicians Notice

                      English    Spanish

• Supervisor's Accident Investigation
• No Injury Certificate
• Managed Care Compliance Kit
• Matrix Pharmacy Program Kit for FL, GA, AL, NC & SC
• Grievance Procedure Letter

                     English    Spanish

• Introductory Letter to Physician

                     English    Spanish

• Refusal of Treatment

                     English    Spanish 

EMPLOYMENT FORMS

• Employee Agreement

                      English    Spanish

• Medical History Questionnaire

                      English   Spanish

• Letter of Agreement w/Independent Contractor
• Post-Injury Drug Testing Consent

                      English    Spanish

MISCELLANEOUS

• Policyholder Contact Form Click here
• Policyholder Contact Form
• Agent Online Contact Form Click here
• Agent Online Contact Form

• Electronic Premium Payment Authorization
• Contractor's Premium Credit Application
• 2006 Contractor's Supplement Application
• Restaurant Supplement
• Notice of Exception to be Exempt
• Florida Workers' Compensation Acord Application
• Post-Injury Drug Testing Kit
• Post-Injury Drug Testing Application
• Drug-Free Premium Credit Application
• Certification for Safety Credit
• Request for Safety and Health Consultation
• South Carolina Employer's Withdrawal of Election to Adopt the SC Workers' Compensation Act
• New! South Carolina Application for Drug- and Alcohol-Free Workplace Premium Credit Program

PAYROLL AUDIT FORMS

• Quarterly Audit Letter
• Quarterly Audit Form
• Final Audited Payroll Dispute Form 

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SAFETY & LOSS CONTROL

• Hazard Communicaton Program   
• Flexibility-Dexterity Test   
• Workplace Safety Program

SAFETY & FRAUD INFORMATION

• Safety & Fraud Posters

  

      -  English 

    -  Pre-printed  

    -  Spanish

• Fraud Red Flags

• Ergonomics

    -  OSHA: Stategy for Success

    -  Workstation Design Principals

    -  Repetitive Hand & Wrist Tasks

• Safety Partners

    -  Nu-Safe Floor Solutions

    -  Shoes for Crews

    -  FLA Orthopedics, Inc.

    -  Alpha Pro Tech

    -  Workers' Comp Solutions