These forms are available for completion and online submission through the Board's website. To access a form, select the form number or title. If registration is required, a login screen will prompt you for your user ID and password. Complete the online application to register for Web Submission of Claim Forms.
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 Number | Form Title | Registration required? | Comments |
|---|---|---|---|
| C-8.1B | Notice of Objection to a Payment of a Bill for Treatment Provided | Yes |
Treatment issue: within 5 days after terminating medical care or refusing authorization. Disputed bill: within 45 days of submission of bill. |
| DB-470 | Preliminary/Final Claim for Reimbursement of Benefits Paid Under Disability Benefits Law | Yes | Submitted prior to award of workers' compensation benefits. |
| PH-16.2 | Pre-Hearing Conference Statement | No | Filed ten days before scheduled pre-hearing conference for controverted cases (FROI-04/SROI-04). |
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.