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Division of Workers' Compensation

Claims

Form

Description


Workers’ Claim for Compensation 
Form #WC15

Fillable
MS Word

This form is filed by the injured worker and provides notice to the Division and insurer that workers’ compensation benefits are claimed.

Dependent’s Notice and Claim for Compensation  
Form #WC18

Fillable
MS Word
 

This form is filed by the dependents of a deceased worker and provides notice to the Division and the insurer that workers’ compensation dependent’s benefits are claimed.

 

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