Notice of Political Subdivision Workers’ Compensation Alliance Requirements for Work-Related Injuries
Fund members are required to post this notice advising their employees of Alliance requirements. Available in English and Spanish.
This notice must be posted in personnel and/or administration as well as in every building to ensure employees have access to this information. Virtual posting of this notice alone does not fulfill state requirements for posting.
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This information is exclusively for Fund members with Workers' Compensation coverage.
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Bona Fide Offer of Employment Template
When the doctor clears your injured employee to return to work, use this template to issue a bona fide offer of employment that meets state requirements.
Employee Acknowledgement of Alliance Direct Contracting Program
Employees must sign this form acknowledging they understand how to receive health care in the Political Subdivision Workers’ Compensation Alliance. Available in English and Spanish.
Electronic Funds Transfer Payment Form
Complete and submit this fillable form to authorize the Fund to draft invoice payments from your organization's bank account.