If you would like the Board to take action on your claim, you can file Form RFA-1W - Request for Assistance by Injured Worker.
This form should be used if you have a claim that is accepted by the insurer.
It should not be used for claims that are:
- controverted by the insurer, or
- claims that the insurer has not yet accepted.
If you are not sure whether the insurer has controverted or accepted your claim, call the Workers' Compensation Board at (877) 632-4996 and we will be happy to assist you.
Reasons for Filing RFA-1W
File an RFA-1W if:
- You are out of work (and have been out of work for more than seven days) and are not receiving compensation benefits.
- You have returned to work and are earning less money because of your work-related injury or illness and seek a reduced earnings award.
- Your payments have been stopped or reduced and you don't think they should have been.
- You attended a hearing where the Judge directed the insurance carrier to pay you an award but more than ten days have passed and you have not received the award.
- Your doctor wants to perform medical treatment but has not received the necessary authorization from the insurance carrier.
- You have medical documents that indicate your condition is permanent or your medical condition has changed.
- You submitted a request for medical and transportation reimbursement, Claimant's Record of Medical and Travel Expenses and Request for Reimbursement (Form C-257) which was denied by the insurance carrier or not responded to.
- You have been released from incarceration and your compensation benefits should resume.
- You have returned to work at full pay and want to notify the Workers' Compensation Board.
How to File Form RFA-1W
File online: Request for Assistance by Injured Worker (Form ERFA-1W)
OR
File paper form:
- Download - Request for Assistance by Injured Worker (Form RFA-1W)
- Fill out form and mail, fax or email form to the Board.
You must also send a copy of this form to the insurance carrier or to your employer or their third-party administrator if your employer is self-insured.
Other Ways to Get Help
Learn about other Board services that are available to help you, or contact the Board's Advocate for Injured Workers.
If you would like to follow your claim online, you can register for eCase.