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WCC PDF Forms

Form NameForm Number
Employee's Request For Informal Permanent Disability RatingDEU 200
Employer's Report Of Occupational Injury Or IllnessDLSR 5020
Faculty Disclosure of Commercial InterestQME Form 119
Fee Disclosure StatementDWC 3
Finding and Order (Replacement QME Represented)
Finding and Order (Replacement QME Unrepresented)
Finding and Order RE: Second QME Panel (Unrepresented Case)
Finding and Order RE:Second QME Panel (represented case)
For More InformationFact Sheet #4
Frequently Asked Questions Regarding the Self Insurer's Annual Report
General Information and Instructions, Effective for Dates of Service on or after January 1, 20049789.11(a)(1)
General Information and Instructions, Effective for Dates of Service on or after July 1, 20049789.11(a)(1)
Getting Appropriate Medical Care for Your Injury (October 2006)
Glossary of workers' compensation terms for injured workers (07-2005)Fact Sheet B
Glossary of workers' compensation terms for injured workers - Spanish (09-2005)Fact Sheet B
HCO Enrollment FormWC-HCO1
Help in Returning to Work10133.2
How to correctly name your employer for the Uninsured Employers Fund (05-2007)IA16A
How to correctly name your employer for the Uninsured Employers Fund - Spanish (07-2007)IA 16A
How to File a Claim with the Uninsured Employers Fund - Form and Instruction Packet - SPANISH (05-2007)I&A16(sp)
How to File a Claim with the Uninsured Employers Fund - Forms and Instructions (05-2007)I&A 16
How to file a complaint with the Audit Unit (06-2006)DWC-AU-905
How to Request A QME-If you do not have a lawyerIMC 105
Hurt on the Job? for Young WorkersFact Sheet Young Workers
Hurt on the Job? for Young Workers (SP)Fact Sheet Young Workers
Indemnity Notices Resumption, Change, Termination - Instructions
Independent medical review application
Information Guidelines for Submission of Settlement DocumentsSet guide
Information Request FormWCAB-7A
Information Response FormWCAB-7B

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