Employees

First Report of Injury

• Confirm First Report Filing

Forms

• Request for Assistance - SF 45442 (Informal Assistance)
• Application for Adjustment of Claim - SF 29109 (Formal Hearing Process)
• Application for Review by Full Board - SF 1042
• Application for Second Injury Fund Benefits - SF 51247
• Request for Prosthetic Repair or Replacement - SF 51702
• 2nd Injury Fund

Hearing Schedule

• Search Disputed Claims

Additional Resources for Injured Workers

• Who Is Eligible?
• Scholarship Program for Children of Injured Workers
• Should an injured worker have attorney representation?
• Find a Comp Attorney