Claims Coordinator Resources

Handbook

• Claims Coordinator Handbook (PDF)

Brochure

• Brochure – Workers’ Compensation Benefits for State Employees (PDF)

Checklists

• Claims Coordinator Checklist (PDF) – List of which forms must be sent to SORM, when, and how to submit them. Recommended: make a copy for every new claim, as applicable.
• Subrogation Checklist (PDF) – Important information a claims coordinator can obtain to assist SORM in third-party liability investigations. Recommended: make a copy for every new claim, as applicable.

Senate Bill

• Senate Bill (SB) 22

Forms

• SORM-29 – Employee’s Report of Injury
  • SORM-29 English Form (PDF)
  • SORM-29 Spanish Form (PDF)
• SORM-80 – Employee’s Election Regarding Utilization of Sick and Annual Leave
  • SORM-80 English (PDF)
  • SORM-80 Spanish (PDF)
• SORM-80 (PO) – Employee’s Election Regarding Utilization of Sick and Annual Leave for Peace Officers (PO)
  • SORM-80-PO Form (PDF)
  • SORM-80-PO Form (Word)
• SORM-74 – Witness Statement
  • SORM-74 English Form (PDF)
  • SORM-74 Spanish Form (PDF)
• SORM-16 – Authorization for Release of Information
  • SORM-16 English Form (PDF)
  • SORM-16 Spanish Form (PDF)
• DWC-48 – Travel Reimbursement (PDF)
• SORM-85 – Return-to-Work Policy (Word)
• DWC-73 – Work Status Report (PDF)
• SORM-703 – Incident/Accident Investigation Form. RMTSA Guidelines
  • SORM-703 Form (PDF)
  • SORM-703 Form (Word)