Google Translate

Search by form number, title, or keyword
Leave blank for all. Otherwise, the first selected term will be the default instead of "Any".

Publications and Forms

Noncompliance Referral Form (WC-258)

Complete the form to report a business for not carrying workers' compensation insurance.

Proposed Rates for Group Trust Self-Insurance (WC-127)

A form to submit proposed rates for a self-insured group trust.

Questions and Affidavit Regarding Benefit Sources and Payments - Affidavit Form A (WCT-2)

Questions and affidavit for claimant regarding benefit sources and payments, form A.

Questions and Affidavit Regarding Completeness of Medical Information Submitted - Affidavit Form E (WCT-6)

Questions and affidavit for claimant regarding completeness of medical information submitted, form E.

Questions and Affidavit Regarding Due Diligence in Enforcing the Judgment - Affidavit Form D (WCT-5)

Questions and affidavit for claimant regarding due diligence in enforcing the judgment, form D.

Questions and Affidavit Regarding Lost Income - Affidavit Form B (WCT-3)

Questions and affidavit for claimant regarding lost income, form B.

Questions and Affidavit Regarding Waiver of Final Judgment and Requirement - Affidavit Form C (WCT-4)

Questions and affidavit for claimant regarding waiver of final judgment and requirement, form C.

Request by a Health Care Provider for Case Status Information to file a Medical Fee Dispute Application (WC-194)

A form for use by health care provider to determine case status information to file a medical fee dispute application.

Request for Conference (WC-182)

Request to DWC for conference regarding workers’ compensation case.

Request for Award on Undisputed Facts in Regard to Application for Direct Payment (WC-201)

A request by an employer or insurer for an award on undisputed facts in regard to application for a direct payment medical fee dispute.

Pages