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Workers' Compensation Board

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Flat File Transmission of Claim Information

List of Claim Forms Available for Flat File Transmission
Form ID Form Title
C-2 Employer's Report of Work-Related Injury/Illness
C-7 Notice that Right to Compensation is Controverted
C-11 Employer's Report of Injured Employee's Change in Status or Return to Work
C-240 Employer's Statement of Wage Earnings
C-669 Notice to Chair of Carrier's Action on Claim for Benefits
C-8/8.6 Notice that Payment of Compensation Has Been Stopped or Modified
C-8.1 Notice of Treatment Issue(s)/Disputed Bill Issue(s)
DB-470 Preliminary/Final Claim for Reimbursement of Benefits Paid Under Disability Benefits Law
RFA-1 Claimant's Request for Further Action
RFA-2 Carrier's/Employer's Request for Further Action
VF-2 Political Subdivision's Report of Injury to Volunteer Firefighter
VAW-2 Political Subdivision's Report of Injury to Volunteer Ambulance Worker