Use this as a private worksheet
Organize the claim by document type instead of keeping one unsorted file. This is not an official agency or court form.
Claim and agency papers
- ☐ Injury report: ______________________________
- ☐ Claim form: ______________________________
- ☐ Acceptance or denial notice: ______________________________
- ☐ Hearing/appeal papers: ______________________________
Medical
- ☐ First treatment note: ______________________________
- ☐ Diagnostic tests: ______________________________
- ☐ Work restrictions: ______________________________
- ☐ Referrals or authorization decisions: ______________________________
Work and wages
- ☐ Job description: ______________________________
- ☐ Pay stubs: ______________________________
- ☐ Schedules: ______________________________
- ☐ Light-duty offers: ______________________________
Communication
- ☐ Employer messages: ______________________________
- ☐ Insurer/adjuster letters: ______________________________
- ☐ Agency correspondence: ______________________________
- ☐ Call log: ______________________________
Privacy reminder
Keep sensitive medical, wage, claim-number, and employment information private. Share it only with appropriate official agencies, licensed professionals, insurers, treating providers, or other people who legitimately need it for the claim.