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Publications and Forms

Substitution of Counsel (WC-237)

A request for substitution of counsel in a workers' compensation case.

Surplus Distribution Request (WC-265)

A form requesting authority to distribute surplus monies of a self-insured group trust.

Trust Quick Reference Due Dates (WC-193)

A quick reference for group trust reporting requirements.

Workers' Compensation Subpoena (WC-25-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a hearing.

Workers' Compensation Subpoena Duces Tecum (WC-25-A-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a hearing.

Workers' Compensation Subpoena Duces Tecum For Deposition (WC-25-C-AI)

A subpoena for a workers compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a deposition.

Workers' Compensation Subpoena For Deposition (WC-25-B-AI)

A subpoena for a workers compensation case requiring the attendance of an individual at a deposition.

Affidavit for Security Release (WC-264)

A sample affidavit for former self-insured employers requesting release of security.

Affidavit of Exemption for Workers' Compensation Insurance (WC-134)

An affidavit that construction industry business owners who are not required to purchase workers’ compensation insurance may use to aid them in obtaining business licenses from some cities and counties.  Note: This form should not be sent to the Division of Workers’ Compensation.

Application for Authority to Self-Insure (WC-81)

The application to be completed by an employer applying to individually self-insure.

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