Important Forms To Fill Out After a WC Accident

THESE FORMS NEED TO BE FILLED OUT WITH GREAT DETAIL! IF YOU FAIL TO CLAIM A BODY PART, IT WILL BE EXTREMELY HARD TO RECEIVE TREATMENT TO THAT AREA!

Forms are in PDF format. The Board recommends using the latest version of Adobe Reader  which is available as a free download from Adobe's web site.

After the form opens in your browser, you may complete the form by typing information on the form before you print it.

IMPORTANT: Two-sided and multi-page forms are to be printed and submitted to the Board in duplex format. If this is not possible, submit as separate sheets. However, do NOT submit to the Board any sheets that contain only instructions and/or reference material. Parties of interest other than the Board must receive both sides of all two-sided forms and all pages of multi-page forms.

If you require assistance with completing these forms, please contact your local WCB District Office.