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Home / Forms

Electronic Forms                

 

Attorney Leave Request Form

Attorney Change of Address Form

Copier Account Maintenance Form 

Mediation Conference Report

Compliance Whistle Blower Notice

Forms

                            

Form Number Title
CC- Form 1A  Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees
CC - Form 1A Spanish  Aviso e Instrucción de Compensación de Trabajadores de Oklahoma para  Empresarios y Trabajadores
CC - Form 3

 Employee's First Notice of Claim for Compensation

*Note: This is not a first report of injury. Consider contacting your insurance company to make a First Report of Injury before you file a claim via CC-Form 3.

 

CC - Form 3A

 Claimant's First Notice of Death and Claim for Compensation

 

CC - Form 3B

 Employee's First Notice of Occupational Disease and Claim for Compensation

 

CC - Form 3C  Claim for Workers' Compensation Discrimination or Retaliation
CC - Form 3F

 Employee's Notice of Claim for Benefits From the Multiple Injury Trust Fund

 

CC -  Form 5  Physician's Report of Release and Restrictions
CC- Form 7  Designation of Service Agent
CC - Form 9  Request for Hearing
CC - Form 10  Answer and Notice of Contested Issues
CC - Form 10A  Respondent's Response to Claimant's Application for Change of Physician
CC - Form 10C  Employer's Response to Claim for Workers' Compensation Discrimination or Retaliation
CC -  Form 13  Request for Prehearing Conference
CC - Form 17  Physician Disclosure Statement
CC - Form 20  Proof of Loss (Death Claim)
CC - Form 36A

Affidavit of Exempt Status

(Fill Out and File Your Affidavit of Exempt Status Online by Clicking This Link)

CC-Form 36C Cancellation of Affidavit of Exempt Status
CC - Form 40  Request for Review of Proposed Judgment
CC - Form 50 Medical Interlocutory Order Request
CC - Form 71  Authorization for Attorney Representation
CC - Form 93  Application and Order for Leave to Withdraw as Attorney of Record
CC - Form 99  Pauper's Affidavit
CC - Form 100  Claimant's Application and Order for Dismissal
CC - Form 463  Application for Independent Medical Examiner
CC - Form 626  Medical Case Manager Application
CC - Form 862  Vocational Rehabilitation Services (VRS) Registry Form
CC - Form 926  Application for Appointment as Certified Workers' Compensation Mediator
CC - Form A Order  Order for Change of Treating Physician
CC- Form A  Claimant's Application for Change of Physician and Request for Hearing
CC - Form M  Request for Appointment of Independent Medical Examiner, Rehabilitation Evaluator, or Medical Case Manager
CC - Form V  Verification of Permanent Total Disability
CC - Joint Petition  Joint Petition Settlement
Certificate to Joint Petition  
Death Claim Settlement Order  
Form JP Appendix  Joint Petition Settlement Appendix
Form - SI Bond  Surety Bond - Sample Form
Form - SI LOC  Letter of Credit- Sample Form
Mediation Agreement  
Mediation Conference Report  
Mediation Request Form  
MFDR Form 10M  Response to Provider Request for Medical Dispute Resolution
MFDR Form 19  Provider Request for Medical Fee Dispute Resolution
Notice to Injured Workers  
Request For Claims File Information  Prior Claims Request
Subpoena (OKC)  
Subpoena (Tulsa)  
Copy Request Form  

Certificate of Readiness

 

 

(All Forms submitted to the Commission shall be in black print on white paper. Please do not use colored forms.)

                                                      

                                                        Click here to access Court forms.

 


Worksheets

Nunc Pro Tunc

Last Modified on 07/06/2023
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