The forms can be filled in on the computer. My lost wage payment is subject to additional statutory offsets.This is a procedure in which a personal injury claim goes before one or more arbitrators to resolve a dispute. Mandatory arbitration agreements requiring confidentiality undermine the government's ability to enforce worker protection laws. (a) Application to compel arbitration; stay of action. Automobile Negligence and Insurance Related Forms. The insurance contract. When filing a claim online, you have the option to electronically sign the Submission Agreement while completing the online Claim Information Form. The agency must fill out their section of the form within three business days and send it to the insurance carrier for processing. Costing – Calculating how much a change in wages, benefits, differentials, and other economic factors cost the employer.