2nd Injury Fund Forms
2008 Assessment
- 2008 2nd Injury Recommendation Report and Assessment
- 2008 Certificate
Please select the appropriate form below.
2007 Assessment
- 2007 2nd Injury Recommendation Report and Assessment
- 2007 Certificate
Because the assessment calculations differ between carriers and self-insured employers, we have created a unique certification form for each. Please select the appropriate form below.
2006 Assessment
- 2006 2nd Injury Recommendation Report
- 2006 Assessment
- 2006 Certificate
2005 Assessment
- 2005 2nd Injury Recommendation Report
- 2005 Assessment
- 2005 Certificate
2004 Assessment
- 2004 2nd Injury Recommendation Report
- 2004 Assessment
- 2004 Certificate
2003 Assessment
- 2003 2nd Injury Recommendation Report
- 2003 Assessment
- 2003 Certificate
- Second Injury Fund Acturial
Injured Employee Assistance
Prosthetic Applications
Past Years Assessment Information
- 2002 2nd Injury Recommendation
- 2002 2nd Injury Notice of Assessment
- 2002 2nd Injury Certificate
- 2001 2nd Injury Recommendation
- 2001 2nd Injury Notice of Assessment
- 2001 2nd Injury Certificate
- 2000 2nd Injury Recommendation
- 2000 2nd Injury Notice of Assessment
- 2000 2nd Injury Certificate
- 1999 2nd Injury Recommendation
- 1999 Assessment Notice
- 1999 Assessment Notice - Addendum
- 1999 2nd Injury Certificate
Top FAQsI Want To...
- Can an employer terminate me while on Worker's Compensation?
- What benefits are available to injured workers under the Worker’s Compensation A...
- Can my employer fire me while I am off work because of a workplace injury?
- Can I go to my own doctor?
- What if I don’t want to go to the doctor that the employer uses?
