Application for Temporary Total Disability Benefits (PDF)
Application for Temporary Total Disability Benefits-Extraordinary Circumstances (PDF)
Change of Address Form (PDF)
Light Duty Agreement (PDF)
Reimbursement Voucher (PDF)
BROCHURES
- Injured Worker’s Guide to Reporting an Injury
- Information for Injured Workers
- Claimants Guide to Workers’ Compensation
INJURED WORKER DEBIT CARD (RELIACARD®) INFORMATION
Injured workers receiving indemnity benefits as a result of their work-related injury, will automatically be enrolled to receive benefit payments via a US Bank Reliacard® debit card. If the injured worker would like to change the payment option to direct deposit of a financial institution of their choice, please contact the assigned claims analyst or (307) 777-7441 to begin the process.
- ReliaCard® Enrollment Form (PDF)
- ReliaCard® FAQs (PDF)
PROVIDER INJURED WORKER EMPLOYER RESOURCE SYSTEM (PIERS)
The Provider, Injured Worker, and Employer Resource System (PIERS) can be used to find claim information, billing status, payment, and benefit information.