Labor Market Survey

Below is the online referral form for Labor Market Survey. The fields marked in red with a (*) are mandatory and require an entry. Please provide all available information as it will increase the efficacy of our initial review. There is a section below to upload documents such as medical records or other pertinent information. A coordinator will contact you within 24 business hours to confirm receipt of your information and discuss the referral.

Please upload any pertinent documents including: LS202, LS203, LS207, LS208; Average Weekly Wage; recent medical records (within the last year) such as MMI report, PPD rating, most recent work status form; any discovery cut-off/trial dates; injured worker’s employment application and/or resume.

If there is a difference in medical opinion regarding work capabilities, please provide the restrictions from all providers. If the average weekly wage is disputed, please provide both. An employment application/resume helps us determine transferable skills gained from previous employment. Please feel free to include any other information or documentation you feel is relevant to determining suitable alternative employment.
  • Employee Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Documents/Information Required

  • Adjuster Info

  • Please include any other information for which there was no specific field and/or that you feel is relevant to the referral. Additionally, please include any specific instructions or sensitivities for this referral.
  • Claimant Attorney Information

  • Defense Attorney Information

  • By clicking submit you understand that you are submitting potentially sensitive information for the purpose requesting services from Labor Management Services, Inc. and you agree that you are authorized to disseminate this information. All supplied information is transmitted via Secure Socket Layer (SSL) technology. Please view our Privacy Policy for more information.