Electronic Forms
Attorney Change of Address Form
Copier Account Maintenance Form
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 | |
(All Forms submitted to the Commission shall be in black print on white paper. Please do not use colored forms.)
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