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The Commission offices will be closed on Monday, February 2, 2026, due to inclement weather. They will reopen on Tuesday, February 3, 2026.

 

Renovations will begin at the Commission offices on Tuesday, January 20, 2026. Please contact the Commission if accessibility accommodations are needed. Thank you for your patience while we improve our workspace. 

 

Advisory Notice: 2026 updated courtroom and hearing preferences for Commissioner Michael Campbell. The full advisory may be accessed here.

 

Advisory Notice: 2026 Maximum Weekly Compensation Rate. The full advisory may be accessed here.

 

Advisory Notice: 2026 Medical Services Provider Manual. The full advisory may be accessed here.

 

Advisory Notice: New Policy Regarding Electronic Devices in Courtrooms and Adjacent Areas. The full advisory may be accessed here.

 

 

Claimant Forms

FormDescriptionPDFDocFee
16Agreement for Permanent Disability/ Disfigurement CompensationPDFDoc$50.00 if Claimant Represented
16AAgreement for Permanent Disability/ Disfigurement Compensation (injuries after July 1, 2007)PDFDoc$50.00 if Claimant Represented
17Receipt of CompensationPDFDocNo Fee
20Statement of Earning of Injured EmployeePDFDocNo Fee
24Application for Lump Sum AwardPDFDoc$50.00
27SubpoenaPDFDocNo Fee
30Request for Commission Review (Appellate Panel Review)PDFDoc$150
32Request to Waive Filing FeePDFDocNo Fee
50Employee's Notice of Claim or Hearing RequestPDFDoc$50/ Hearing Request only
52Employee's Notice of Claim or Hearing Request (Death Claim)PDFDoc$50.00/ Hearing Request only
58Pre-Hearing BriefPDFDocNo Fee
59Appellant's Informational BriefPDFDocNo Fee
65Occupational Disease WaiverPDFDocNo Fee
S-2Notice of Third-Party Action (Employee)PDFDocNo Fee
 Single Commissioner Decision & Order Template DocNo Fee
 Appellate Panel Decision & Order Template DocNo Fee
 Certificate of Service DocNo Fee