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Workers' Compensation Forms

The workers’ compensation community is encouraged to eliminate paperwork by filing and managing their claims online through WCAIS.

FAQs and detailed instructions for using the system can be found in WCAIS’ online help section, where you will find How-To Guides for completing numerous actions.

LIBC Forms Spreadsheets

Welcome to the department's Workers' Compensation LIBC Forms Spreadsheets. These spreadsheets are designed to provide the workers' compensation community with a reference on forms usage in conjunction with WCAIS. The spreadsheets provide information relating to available methods of submitting forms to the bureau and the Workers' Compensation Office of Adjudication, forms that must be sent to the claimants, when the revised forms will be required, as well as which forms must be sent to the Workers’ Compensation Office of Adjudication.

Please appreciate that these spreadsheets are being provided as a resource to assist the community but do not supersede any statuary or regulatory requirements relating to forms filing. When a copy of a form is required by law to be provided to another party, a true and correct copy of such data and information must be provided to that party consistent with the act, regulations and/or any applicable department-issued policy statement or written guidance.

WC FORMS NOTICE: The workers' compensation forms listed on the LIBC Forms Spreadsheets are provided for your immediate use. However, the Bureau of Workers' Compensation and the Workers' Compensation Office of Adjudication require their use on the effective dates noted on the spreadsheets. Previous versions of these forms submitted after their effective dates will not be accepted and will be returned to the filing party.

However, the BWC WCAIS Team is currently evaluating the process for the use of revised BWC forms that require signatures, such as agreements and supplemental agreements, in relation to the previously announced June 30, 2014, use date. Until further determination has been communicated, the bureau will continue to accept the pre-WCAIS and post-WCAIS version of a form that requires the claimant's signature, such as agreements and supplemental agreements. Note that this applies only to BWC forms. The most recent revised WCOA forms, as available on the spreadsheet, must still be submitted. Please also note that BWC forms will only be returned if there is no EDI transaction filed to establish a claim. Thank you for your attention concerning this matter.

BWC Forms
WCOA Forms
WCAB Appeal Form

NOTE: LIBC-510 and LIBC-662 can now only be filed by completing the appropriate screens in WCAIS. Paper forms are no longer available. It is not required that the forms for these be sent to claimants.

WC Forms Submission Reminders

  • File claims and related documents online at Search the help section for FAQs and How-To Guides for common actions.

  • If filing by paper, use a medium point black ink pen on all forms or have them typed.

  • Do not use colored paper.

  • List the appropriate county on the forms when requested.

  • Please double-check the accuracy of the information provided, such as employee name, address and social security number, employer name and address, insurance information, injury date and description of injury.

  • Employee signature on the Notice of Suspension or Modification form (Form LIBC-751) is required only if employee is intending to create an Employee Challenge and request a special hearing regarding the suspension or modification. Employee signature should appear when the Employee Challenge box is checked.

  • Insurer codes are critical to assignment of the claim to the correct insurer and employer address. Insurer codes are four-digit numbers that identify the insurer or self-insured employer for notifications as necessary.

  • Signatures are required on some forms. This is a mandatory requirement if requested on the form.

Answers to Petitions

We encourage you to submit the answers to petitions through WCAIS. You may also submit them directly to the workers' compensation judge assigned to the case.