- Application for Temporary Total Disability Benefits (PDF)
- Application for Temporary Total Disability Benefits-Extraordinary Circumstances (PDF)
- Change of Address Form (PDF)
- Change of Healthcare Provider Form (PDF)
- Light Duty Agreement (PDF)
- Reimbursement Voucher (PDF)
- U.S. Bank Reliacard Disclosures (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)
- ReliaCard® Debit Card Disclosure (PDF)
PROVIDER INJURED WORKER EMPLOYER RESOURCE SYSTEM (PIERS)
这 Provider, Injured Worker, and Employer Resource System (PIERS) can be used to find claim information, billing status, payment, and benefit information.