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WCC PDF Forms

Form NameForm 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 FormForm 10297
Benefit Notice Instruction Manual
Case Initiation DocumentRU 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 FormWCAB-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 FormDWC-AD10133.57
Notice of Change or Rate in Payment ScheduleDWC-500F
Notice of Delay in Determining Liability - Instructions
Notice Of Delay In Determining Liabilty For Workers' Compensation BenefitsDWC 500D

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