Skip to Content

Workers’ Compensation Board

WCB Information Related To Novel Coronavirus (COVID-19)

List of Available Forms for Attorneys and Licensed Representatives

These forms are available for completion and online submission through the Board's web site.

After the Board receives your form, a non-editable PDF version of the form will appear in your web browser. The first page contains a confirmation that your form was successfully submitted to the Board and the date. It should be saved for your records. DO NOT MAIL THIS FORM TO THE BOARD.

Form Instructions

Forms Submitted by Attorneys and Licensed Representatives
Form Number Form Title Registration required? Comments
PH-16.2 Pre-Hearing Conference Statement No Filed ten days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04).
RFA-1LC Request for Further Action By Legal Counsel No The form may be filed at any time after the indexing of a claim or after the Board has indicated that no further action (NFA) will be taken. REPLACES FORM C-89.3.

Note:When filing required documents (e.g. medical evidence indicating permanency), provide the appropriate document identification if it is already in the case folder. If faxing or mailing documents, be sure that each page is properly identified by the WCB case number, claimant name and date of injury.
VDF-1 Loss of Wage Earning Capacity Vocational Data Form No Injured Workers who may have a non-schedule permanent impairment and who have not returned to work are encouraged to complete and submit Form VDF-1 as early as possible in the claim.


If the form you are looking for is not available for online submission, you may print the PAPER version of the form from our list of common forms.