Workers’ Compensation information and forms for the state of NE

Workers’ Compensation Insurance can seem complicated to administer. There are many forms and various specific state regulations concerning postings and employee notification. To get the help you need to ensure employees understand coverage’s and how to report a work place injury, select the link located below.

• 221-10000 – Claim Kit Cover Letter
  Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
• 221-10001 – Take Control of Workers' Compensation Costs
  This guidance will help ensure the best outcome for you and your employees following a work related injury.
• WC7618_NE – Nebraska Posting Notice
  Required to be conspicuously posted at the employer's place of business so all employees have access to it.
• WC8111k – First Report of Alleged Occupational Injury or Illness
  This form is completed by the employer to report an on the job injury or accident involving an employee.
• WC7658b – Employee's Choice or Change of Doctor Form
  To be provided to an injured worker at the time of a work related injury.
• WC7662B – Employee's Choice or Change of Doctor Form (Spanish)
  To be provided to an injured worker at the time of a work related injury.
• WC9949 – Rights & Obligations under the Nebraska Workers' Compensation Law
  Information for employers and employees regarding rights and obligations with regard to workers' compensation.
• WC9950 – Rights & Obligations under the Nebraska Workers' Compensation Law (Spanish)
  Information for employers and employees regarding rights and obligations with regard to workers' compensation.
• WC9951 – Choosing a Doctor for a Work-Related Injury
  To be provided to an injured worker at the time of a work related injury.
• WC9952 – Choosing a Doctor for a Work-Related Injury (Spanish)
  To be provided to an injured worker at the time of a work related injury.