In observance of Thanksgiving, WCC offices will be closed on Thursday, November 24, 2022.

Hearing Forms

 

link opens in new browser tab  Hearing Request

PDF File:  1 page; Last revised July 13, 2009
 

Hearing Request

The Hearing Request form is to be completed by any party to a claim or his/her attorney/representative who wishes to request an Informal, Pre-Formal, Formal, Stip Approval, or Disfigurement/Scar hearing before an Administrative Law Judge in one of the Commission's eight District Offices.

 


 

link opens in new browser tab  Petition for Review

PDF File:  1 page; Last revised October 1, 2021
 

Petition for Review

The Petition for Review form is to be completed by any party to a claim or his/her attorney/representative who wishes to file an appeal with the Workers’ Compensation Commission’s Compensation Review Board (CRB).

 


 

link opens in new browser tab  Notification of Appearance

PDF File:  1 page; Last revised March 17, 2006
 

Notification of Appearance

The Notification of Appearance form must be completed by the attorney/representative of any party to a claim to notify the Workers’ Compensation Commission of who will be representing that particular party before the Commission.

 


 

link opens in new browser tab  Hearing CANCELLATION Request

PDF File:  1 page; Last revised October 1, 2021
 

Hearing CANCELLATION Request

The Hearing CANCELLATION Request form is to be completed by any party to a claim or his/her attorney/representative who wishes to cancel a previously-scheduled Informal or Pre-Formal hearing before an Administrative Law Judge. (It is not to be used for a Formal hearing.)

[NOTE: Read about the Hearing Cancellation Request Form for Informal and Pre-Formal Hearings BEFORE using this form.]

 


 

The Workers' Compensation Commission recommends the use of Adobe's free Adobe Acrobat Reader software application when accessing or using its PDF forms and publications.

Get the Adobe Acrobat Reader by clicking the following button:   Get Adobe Acrobat Reader

The Workers' Compensation Commission's recommendation of Adobe's free Adobe Acrobat Reader software application is based solely on technical considerations inherent in the PDF files this agency produces, and does not constitute an endorsement of Adobe Software as a company or of its commercially-available products. There are a multitude of free and commercial software applications offered by various software makers that are capable of opening and displaying our PDF documents, but only the Adobe Acrobat Reader application makes full and accurate use of the capabilities we have built into our documents; the agency has found over a period of many years that the Adobe Acrobat Reader provides the best, most trouble-free experience using this Commission's PDF files.