WC Forms Submission Reminders

  • 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 on forms 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 directly to the workers' compensation judge assigned to the case.

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. These spreadsheets provide information relating to available methods of submitting forms to the bureau and 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 Department of Labor & Industry website 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 website. Previous versions of these forms submitted after their effective dates will not be accepted and will be returned to the filing party.
 
 
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.
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