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

Insurance Forms


link opens in new browser tab  Form 36

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

Notice of Intention to Reduce or Discontinue Payments

The Form 36 is to be completed by the respondent (employer/workers’ compensation insurance carrier) to notify the Workers’ Compensation Commissioner, the claimant (employee/decedent), and all parties to the claim of its intention to reduce or discontinue payment of the claimant’s workers’ compensation benefits.



link opens in new browser tab  Form 44

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

Order to Second Injury Fund in Cases of Concurrent Employment

The Form 44 is to be completed by a workers’ compensation insurance carrier seeking reimbursement from the state Second Injury Fund. Once both the carrier and the Fund agree on the figures and sign the form, it is sent to the Commission for approval.

[NOTE: Read Memorandum No. 2004-04 for complete instructions regarding the filing of 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.