As of July 1, 2022, there have been changes to many of the State Board forms. Beginning October 1, 2022 outdated forms will be returned. The majority of the changes were minor and were to reflect the increase in the maximum TTD an TPD rates, $725 and $483 respectively, for all injuries occurring after July 1, 2022.

We have updated the typable versions of the forms in house.  If you need a copy if the newly updated, typable, forms please let us know and we would be happy to get you a copy.

Specially the other changes that are reflected in the updates are:  The maximum benefit in death claims has increased as well to $290,000.00. The WC-P1 or Panel of Physicians has also been modified. The State Board’s name and address is no longer included on the Panel and has been replaced by “Physician’s Names.” The updated WC-14 Notice of Claim/Request for Hearing/Request for Mediation and WC-14a Request to Change Information on a Previously Filed Form WC-14 now include a phone number block for all parties. Minor changes include the WC-Change of Information adding “Birthdate” to the instructions and the WC-12 Request for Copy of Board Records replacing “Doing Business At” with “Doing Business As” in Section B regarding a request for certified employer insurance coverage information. Lastly, there were various formatting changes to the WC-15 Request for Lump Sum or Advanced Payment including: Added language across the top “Check only one”, First box in section B Underlined “Complete sections C, D and F only and removed sentence “No attachments necessary”. Second box in section B change “an advance” to “a lump sum/advance and underline sentence. Third box – remove “C” from sentence and then underline. Section C changed telephone to phone number. Section D – updated the format. Page 2 section E – updated the format. Section F – updated the format. PDF versions of all Board forms, including the updated ones, can be found on the State Board’s website.