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Friday, January 17, 2025 -
WCC PDF Forms
| Form Name | Form Number |
|---|---|
| Answers to your questions about the state's Uninsured Employers Fund (01-2006) | Fact Sheet F |
| Answers to your questions about the state's Uninsured Employers Fund - Spanish (10-2005) | Fact Sheet F |
| Arbitrator Submittal Form | Form 10297 |
| Benefit Notice Instruction Manual | |
| Case Initiation Document | RU 101 |
| Cover Page for Medical Provider Network Application (05/2007) | DWC form 9767.4 |
| Denial of Vocational Rehabilitation Benefits (RU-500Y) | RU-500Y |
| 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) | |
| Frequently Asked Questions Regarding the Self Insurer's Annual Report | |
| 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 |
| 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 complaint with the Audit Unit (06-2006) | DWC-AU-905 |
| Indemnity Notices Resumption, Change, Termination - Instructions | |
| Information Request Form | WCAB-7A |
| Instructions for Private and Group Self Insurer's Annual Reports (12-2006) | |
| Instructions for Public Self Insurer's Annual Report (2005-2006) | |
| Mandatory Notices For Vocational Training & Return to Work | |
| Medical Mileage Expense Form (01-2009) | I&A mileage form |
| Medical Mileage Expense Form (06-2011) | |
| Medical Mileage Expense Form (07-2008) | I&A mileage form |
| Medical Mileage Expense Form - English and Spanish (01-2008) | |
| Nontransferable Training Voucher Form | DWC-AD10133.57 |
| Notice of Change or Rate in Payment Schedule | DWC-500F |
| Notice of Delay in Determining Liability - Instructions | |
| Notice Of Delay In Determining Liabilty For Workers' Compensation Benefits | DWC 500D |
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