The Commission welcomes Commissioner Deidra Byrd. We are honored to have her on board and thank her for her service to the Commission. Full advisory may be accessed here.

 

Ms. Blanca Marcus has resigned as Self-Insurance Director effective September 11, 2026. The Commission thanks her for her service. The full advisory can 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