2007 Workers' Compensation Board Forms
| Form |
Explanation |
| Form WC-1. Employer's First Report of Injury | Board Rule 61(b)(1) |
| Form WC-2. Notice of Payment or Suspension of Benefits | Board Rule 61(b)(2) |
| Form WC-2A. Notice of Payment or Suspension of Death Benefits | Board Rule 61(b)(3) |
| Form WC-3. Notice to Controvert | Board Rule 61(b)(4) |
| Form WC-4. Case Report | Board Rule 61(b)(5) |
| Form WC-6. Wage Statement | Board Rule 61(b)(6) |
| Form WC-10. Notice to Elect or Reject Coverage | Board Rule 61(b)(7) |
| Form WC-11. Standard Coverage Form | Board Rule 61(b)(8) |
| Form WC-12. Request for Copy of Board Records | Board Rule 61(b)(9) |
| Form WC-14. Notice of Claim/Request for Hearing or Mediation | Board Rule 61(b)(10) |
| Form WC-14A. Request to Change Information on a Previously Filed Form WC-14 | Board Rule 61(b)(11) |
| Form WC-15. Attorney Certification for No-Liability Stipulated Settlements | Board Rule 61(b)(12) |
| Form WC-20(a). Medical Report | Board Rule 61(b)(13) |
| Form WC-24. Enforcement Division Request for Board Intervention | Board Rule 61(b)(14) |
| Form WC-25. Application for Lump Sum/Advance Payment | Board Rule 61(b)(15) |
| Form WC-26. Consolidated Yearly Report of Medical Only Claims and Annual Payments on Indemnity Claims | Board Rule 61(b)(16) |
| Form WC-100. Request for Settlement Mediation | Board Rule 61(b)(17) |
| Form WC-102. Request for Documents from Parties | Board Rule 61(b)(18) |
| Form WC-102B. Notice of Representation by an attorney for an employer, insurer, or party-at-interest | Board Rule 61(b)(19) |
| Form WC-102C. Attorney Leave of Absence | Board Rule 61(b)(20) |
| Form WC-102D. Motion/Objection to Motion | Board Rule 61(b)(21) |
| Form WC-104. Notice to Employee of Medical Release to Return to Work with Restrictions or Limitations | Board Rule 61(b)(22) |
| Form WC-108a. Attorney Fee Approval | Board Rule 61(b)(23) |
| Form WC-108b. Attorney Withdrawal/Attorney Fee Lien | Board Rule 61(b)(24) |
| Form WC-121. Change of TPA Claims Office/Servicing Agent | Board Rule 61(b)(25) |
| Form WC-131. Permit to Write Insurance | Board Rule 61(b)(26) |
| Form WC-131(a). Permit to Write Insurance Update | Board Rule 61(b)(27) |
| Form WC-200a. Change of Physician/Additional Treatment by Consent | Board Rule 61(b)(28) |
| Form WC-200b. Request/Objection for Change of Physician/Additional Treatment | Board Rule 61(b)(29) |
| Form WC-205. Request for Authorization of Treatment or Testing by Authorized Medical Provider | Board Rule 61(b)(30) |
| Form WC-206. Reimbursement Request of Group Health Insurance Carrier/Healthcare Provider | Board Rule 61(b)(31) |
| Form WC-207. Authorization and Consent to Release Information | Board Rule 61(b)(32) |
| Form WC-208a. Application for certification of WC/MCO | Board Rule 61(b)(33) |
| Form WC-226(a). Petition for Appointment of Temporary Guardianship of Minor | Board Rule 61(b)(34) |
| Form WC-226(b). Petition for Appointment of Temporary Guardianship of Legally Incapacitated Adult | Board Rule 61(b)(35) |
| Form WC-240. Notice to Employee of Offer of Suitable Employment | Board Rule 61(b)(36) |
| Form WC-240A. Job Analysis | Board Rule 61(b)(37) |
| Form WC-243. Credit | Board Rule 61(b)(38) |
| Form WC-244. Reimbursement Request of Group Insurance Carrier/Disability Benefits Provider |
Board Rule 61(b)(39) |
| Form WC-262. Payment of Temporary Partial Disability Income Benefits | Board Rule 61(b)(40) |
| Form WC-Change of Address. Change of Address | Board Rule 61(b)(41) |
| Form WC-R1. Request for Rehabilitation | Board Rule 61(b)(42) |
| Form WC-R1CATEE. Employee Request for Catastrophic Designation | Board Rule 61(b)(43) |
| Form WC-R2. Rehabilitation Transmittal Report | Board Rule 61(b)(44) |
| Form WC-R2A. Individualized Rehabilitation Plan |
Board Rule 61(b)(45) |
| Form WC-R3. Request for Rehabilitation Closure | Board Rule 61(b)(46) |
| Form WC-R5. Request for Rehabilitation Conference | Board Rule 61(b)(47) |
| Form WC-Rehabilitation Registration Application | Board Rule 61(b)(48) |
| Form WC-Rehabilitation Registration Application Renewal | Board Rule 61(b)(49) |
| Form WC-Catastrophic Rehab Release | Board Rule 61(b)(50) |
| Form WC-P1. Panel of Physicians |
Board Rule 61(b)(51) |
| Form WC-P2. Conformed Panel of Physicians | Board Rule 61(b)(52) |
| Form WC-P3. WC CO Panel | Board Rule 61(b)(53) |
| Form WC-Bill of Rights. Bill of Rights | Board_Rule_61(b)(54) |
| Subpoena |
