Oklahoma Workers' Compensation Court of Existing Claims
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All PDF files require Adobe Acrobat Reader 11.0 or higher in order to view, print and/or properly fill out the Court Forms. (To get the free Acrobat Reader click the link provided.)

 The following Forms Table provides you easy access to the most current revision of the Court's forms. You may open the blank form by clicking on the 'PDF' link on the right-side of Recordsthe associated Form. Fill out the form, and print the desired number of copies to your local printer for use in submitting to the Court and maintain copies for your records. As part of the function of Adobe Acrobat Reader, the program does allow users to fill-in a form and save the document to your local system.

A supply of blank forms may be printed by users from this Forms Table using the color paper as denoted by the color reference on this table.



Form No. Title Form Color File
1A Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees. Superseded by CC-Form-1A (external link to Workers' Compensation Commission website)    
1A Aviso E Instrucción de Compensación de Trabajadores de Oklahoma para Empresarios Y Trabajadores. Superseded by CC-Form-1A-Spanish (external link to Workers' Compensation Commission website)    
1B Employers Application for Permission to Carry Its Own Risk Without Insurance. Superseded by FORM-SI-EMPLOYER (External link to Workers' Compensation Commission website)    
CS-APPENDIX Compromise Settlement Appendix 6/15   PDF
CCS Certificate to Compromise Settlement. 2/14   PDF
CSD-337 Compromise Settlement. (Death Claim) 6/15   PDF
CS-339A Compromise Settlement. 6/15   PDF
CS-339B Compromise Settlement - Agreement Between Employer and Employee as to Fact with Relation to an Injury and Payment of Compensation. 6/15 PDF
2 Employer's First Notice of Injury. 6/15
(To be used for injuries prior to 02/01/2014)
3 Employee's First Notice of Accidental Injury and Claim for Compensation. 6/15 Yellow PDF
3A Claimant's First Notice of Death and Claim for Compensation. 6/15 Gold PDF
3B Employee's First Notice of Occupational Disease and Claim for Compensation. 6/15 Gray PDF
3E Employee's Claim For Benefits For Combined Disabilities Against the Last Employer.  6/15   PDF
3F Employee's Notice of Claim for Benefits From Multiple Injury Trust Fund. 6/15 Tan PDF
4 Treating Physician's Report and Notice of Treatment. 6/15   PDF
5 Physician's Report on Release and Restrictions. 6/15   PDF
9 Motion to Set for Trial.  6/15   PDF
10 Answer and Pretrial Stipulation Offered by Respondent. 6/15 Green PDF
10A Respondent's Response to Claimant's Form-A Application For Change of Physician. 6/15 Blue PDF
10M Response to Request for Payment of Charges for Medical or Rehabilitation Services. 6/15 Ivory PDF
13 Request for Prehearing Conference. 6/15   PDF
18 Request For Court Administrator Review of Disputed Medical Charges. 6/15 Orchid PDF
19 Request for Payment of Charges for Health or Rehabilitation Services/ Notice of Appeal of Court Administrator Order. 2/14   PDF
20 Proof of Loss (Death Claim). 2/14 Blue PDF
926 Application for Appointment as Certified Workers' Compensation Mediator.   6/15   PDF
93 Application and Order for Leave to Withdraw as Attorney of Record. 6/15   PDF
99 Pauper's Affidavit. 6/15   (two-sided form)   PDF
100 Claimant's Application and Order for Dismissal. 6/15   PDF
A Claimant's Application for Change of Physician and Request for Hearing. 6/15   PDF
A - Order Order for Change of Treating Physician. 6/15   PDF
NPT Request for Nunc Pro Tunc 2/14   PDF
  Copy Request Form. 6/15   PDF
  Vendor Maintenance Form 08/10   PDF
IME - Order Order for Appointment of Independent Medical Examination   PDF
  Trial / PHC Form Order and Instruction for filling out Form.   PDF
  Prior Claims Request Form and instruction for filling out Request Form.   PDF
  Subpoena Duces Tecum (for the production of documents)   PDF
  Subpoena (for appearance)   PDF
  Requisition for Workers' Compensation File - Exempt Requestor   PDF