Forms and Publications


These forms are included in your injured worker packet.

Statement of Injured
Please complete this form with the details of your injury and return it to Summit.

Medical Release
You must sign this form, have it witnessed and return it to Summit in order for us to process your compensation.

Summit Workers’ Compensation Managed Care Program
This brochure is mailed with your injured worker packet. It summarizes the claims process, and includes much of the same information you will find on this website.

Notice of Designated Physician
You and your treating physician should complete this form and return it to Summit.