WORKERS COMP FORMS- Maryland Workman’s Comp

Workers Comp Forms

There are numerous workers comp forms that may be used in any given Maryland claim.  From the beginning of the claim which requires a claim form to be filed to the end of the case that may require numerous settlement forms and documents, injured workers should expect to fill out workers comp forms.

This webpage is a Baltimore workers compensation attorney’s webpage and is not affiliated with any state or governmental entity.  This page may be considered advertisement material.  The information on this page should be take only as information and not legal advice or a consultation.

Workers Comp Claim Form

With only a few exceptions, the first workers comp form that is filed is the claim form.  This is the document that the injured worker will file to begin the process of filing a claim with the Workers Compensation Commission.  NOTE: you may be under the impression that you have filed a claim with workers comp when in actuality, the claim was only filed with the insurance company or agent.  It is extremely important to make sure the correct workers comp form was file with the Commission otherwise the Statute of Limitations may run and the injured worker could lose very valuable benefits.

If you think you have filed a Claim Form but are not sure take a look at the link below and ensure this is the form you have filed.  If you are starting a claim the workers comp form is the one that you should submit to the Workers Compensation Commission:

The Workers Comp Claim Form  (Front Side of workers comp form)
The Workers Comp Claim Form (Back side of workers comp form)

Once the injured worker PROPERLY fills out this form and properly files it with the Commission they will have five years to recover money.  Please note that the form must be filled out properly.  Directions can be found on the workers compensation website.  If this form is not filled out properly and not filed properly the worker may lose all of their legal rights!


Baltimore workers compensation attorney is available to assist in filling out workers comp forms including the workers comp claim form. 

For assistance Call Baltimore workers compensation attorney Andrew M. Rodabaugh for a FREE consultation!  Call Us, Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!


The Issues Workers Comp Form 

The second most common workers comp form an injured worker may file is referred to as the Issues Form.  This form can be used by both the injured worker and the insurance company to request a hearing on any number of different problems in the claim.  It is often used by the injured worker to request past and future lost wages, medical treatment, job training, payment of medical bills, or any other number of issues.  The insurance company may use it to challenge the case on for lack of jurisdiction, accidental injury, causal relationship, or reasonable, necessary and causally related medical treatment.

Once the workers comp Claim Form is filed and the Consideration Date (see definitions) has passed the injured worker can file the Issues Form to request a hearing on any particular relevant issues that may have arisen. 

To view an Issues Workers Comp Form go here.

Workers Comp Form for attorneys entry of appearance

When an injured worker has hired an attorney the attorney is required to file workers comp forms as well as other forms on the injured workers behalf.  The entry of appearance form will be filed with the Commission and will also be sent to the insurance company to put them on notice that an attorney has been retained by the injured employee.  

The workers comp form for an attorney’s entry of appearance can be found here.

Just as an attorney must notify the Commission and the insurance company that they have been retained, If the attorney wishes to withdrawal their appearance they must file the Strike Appearance form.

The workers Comp form for an attorney to Strike appearance can be found here.

workers comp forms

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Workers Comp Form that determines the injured workers Average Weekly Wage

One very important workers comp form is the Wage Statement form which will help determine the injured workers lost wage rates, vocational benefits rate, and could impact the amount of settlement or permanency award.  While Statement of Wages form is not vital in determining these amounts it will provide valuable facts needed to determine an accurate compensation rate.

A miscalculation of the average weekly wage can lead to underpayment of workers comp benefits that could potentially amount to thousands of dollars.  Go here for a thorough discussion of the average weekly wage.  

The workers comp form to determine the average weekly wage can be found here.


Workers Comp Form for the insurance company and workers comp forms for their defense attorneys

There are a number of workers comp forms that are used only by the workers comp insurance company or their attorneys.  The first and most often used form is the C40.  This form is automatically generated and sent to the insurance company when the injured worker files the initial workers comp form, the claim form.  The C40 provides the insruance company and their representatives an opportunity to challenge the claim based on a number of arguments.  The C40 is similar to the issues form in that it provides the insurer the opportunity to request a hearing based on challenging jurisdiction, medical treatment, lost wages or many other defenses.

The workers comp form the insurance company uses to terminate lost wage or temporary total disability benefits was recently added to selection of forms the insurance company uses.  This form is to be filled out by insurance adjusters to notify the injured employees that their lost wage checks will soon be terminated.  Because this workers comp form is relatively new the adjuster unfortunately do not always use it before terminated lost wage payments.

Insurer Termination of Temporary Total Disability Form can be found here

There is a workers comp form that is very similar to the termination of lost wages form, but it is used for termination of medical benefits.  It is to be filled out by the adjuster and sent to the injured workers attorney, the Workers Compensation Commission, and the health care provider.  Unfortunately this form is not always filled out by the adjuster when they terminate medical benefits.  This workers comp form is also a relatively new requirement and adjusters and insurance companies have not yet made it a routine filing despite the Code of Maryland Regulations requiring it.

Insurer Termination of Medical Benefits Disability Form can be found here.

The workers comp form for continuances or postponements

Unfortunately workers comp hearings are postponed from time to time for a number of reasons.  On occasion on of the people involved in a claim may need a postponement if they are not able to attend for a justified reason such as a health condition, previously planned vacation, or a justifiable schedule conflict.  Examples may include the injured worker not being able to attend because of a medical procedure, key witnesses not being able to attend because of a conflict, attorneys not being able to attend because of a scheduling conflict, or the need for more time to properly prepare for the hearing.

Often times the issues that arose at the time the attorney filed for a hearing morph into other issues that would best be heard at a hearing together with the previous issues.  When this happens more medical records or evidence may be needed, or the parties may be able to come to an agreement but simply need more time to negotiate. 

The workers comp form to request a postponement / continuance of a hearing can be found here.

From time to time hearing may be postponed by the Workers Compensation Commission.  They will automatically postpone a hearing if a new party such as the Subsequent Injury Fund has been implead (added) to the claim.  In this event no workers comp form will be filed requesting a postponement. 

Request to implead a party form

The workers comp form used to add or implead a party to any claim can be seen hereIt is used to add a different or additional employer, The Subsequent Injury Fund (SIF), The Uninsured Employers Fund (UEF), or a different insurance company.

Other workers comp forms

There are a litany of other workers comp form that are often filed with the Workers Compensation Commission.  To explain the use of each form is beyond the scope of this article.  Some other commonly used workers comp forms include those relating to job training or vocational rehabilitation, settlement forms, workers comp forms used by medical providers, subpoenas, stipulations, and forms used to make changes to a claim.

Most of the workers comp forms can be found on the Maryland Workers Compensation Commission website, specifically this page.



If you have been injured on the job Call Baltimore workers compensation attorney and Baltimore personal injury attorney Andrew M. Rodabaugh for a FREE consultation!  Call Us, Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!


Mr. Rodabaugh is a valuable asset to his community.  His continuing dedication to the law and his clients is admirable.
Adam SPersonal Injury Attorney


Maryland workers compensation attorney Andrew M. Rodabaugh and his office offers information about Personal Injury law and Workers’ Compensation for informational purposes only. Nothing contained herein constitutes formal legal advice. If you need the advice of a Maryland workers compensation lawyer, please contact him today. He has offices throughout the state and various convenient meeting locations.  Each and every case needs to be evaluated before legal advice can be provided.  Under no circumstance should the information on this website be considered medical advice. This is an attorney’s website and is not affiliated with any government agency or government entity of any kind.
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Workers Comp Forms
Workers Comp forms are used in every Md. comp claim. There are workers comp forms for almost every action needed in the case.
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Work Injury Maryland
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