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Maryland Workers' Compensation Commission Forms

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WCC Form C-2 Statement of Wage Information - Maryland PDF

WCC Form C-2 Statement of Wage Information - Maryland
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WCC Form VR-8 Rehabilitation Service Practitioner Registration Application - Maryland PDF

WCC Form VR-8 Rehabilitation Service Practitioner Registration Application - Maryland
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WCC Form C-3 Claim Amendment - Maryland PDF

WCC Form C-3 Claim Amendment - Maryland
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WCC Form H-34 Stipulation of Parties - Maryland PDF

WCC Form H-34 Stipulation of Parties - Maryland
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Form WCC C18 Certification of Funeral Expenses - Maryland PDF

Form WCC C18 Certification of Funeral Expenses - Maryland
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WCC Form C19 Claim for Funeral Benefits Only - Maryland PDF

WCC Form C19 Claim for Funeral Benefits Only - Maryland
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WCC Form C51 Claim for Medical Services - Maryland PDF

WCC Form C51 Claim for Medical Services - Maryland
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WCC Form H32 Controversion of Medical Claim - Maryland PDF

WCC Form H32 Controversion of Medical Claim - Maryland
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WCC Form IC-16 Exclusion Form - Maryland PDF

WCC Form IC-16 Exclusion Form - Maryland
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WCC Form IC-03 Joint Election Form - Maryland PDF

WCC Form IC-03 Joint Election Form - Maryland
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WCC Form IC-02 Sole Proprietor's Status as a Covered Employee Form - Maryland PDF

WCC Form IC-02 Sole Proprietor's Status as a Covered Employee Form - Maryland
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WCC Form H-12 Request for a Hearing on Previously Withdrawn Issues - Maryland PDF

WCC Form H-12 Request for a Hearing on Previously Withdrawn Issues - Maryland
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WCC Form IC-04 Partner's Status as a Covered Employee - Maryland PDF

WCC Form IC-04 Partner's Status as a Covered Employee - Maryland
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WCC Form H-50 Request for Transcript - Maryland PDF

WCC Form H-50 Request for Transcript - Maryland
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WCC Form H-35 Request for Hearing for Referral to Maryland Insurance Fraud Division - Maryland PDF

WCC Form H-35 Request for Hearing for Referral to Maryland Insurance Fraud Division - Maryland
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WCC Form H-08 Subpoena/Subpoena Duces Tecum - Maryland PDF

WCC Form H-08 Subpoena/Subpoena Duces Tecum - Maryland
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WCC Form VR06 Agreement on the Propriety of Services and Selection of Practitioner - Maryland PDF

WCC Form VR06 Agreement on the Propriety of Services and Selection of Practitioner - Maryland
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WCC Form VR01 Proposed Vocational Rehabilitation Plan - Maryland PDF

WCC Form VR01 Proposed Vocational Rehabilitation Plan - Maryland
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WCC Form H-32 Controversion of Medical Claim - Maryland PDF

WCC Form H-32 Controversion of Medical Claim - Maryland
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WCC Form VR11 Rehabilitation Service Practitioner Application for Waiver of Registration - Maryland PDF

WCC Form VR11 Rehabilitation Service Practitioner Application for Waiver of Registration - Maryland
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WCC Form VR10 Vocational Rehabilitation Provider Enrollment Application - Maryland PDF

WCC Form VR10 Vocational Rehabilitation Provider Enrollment Application - Maryland
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WCC Form VR09 Rehabilitation Service Practitioner Applicant Professional Reference - Maryland PDF

WCC Form VR09 Rehabilitation Service Practitioner Applicant Professional Reference - Maryland
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WCC Form VR12 Registration Waiver Renewal Application - Maryland PDF

WCC Form VR12 Registration Waiver Renewal Application - Maryland
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WCC Form H-05 Claimant's Affidavit in Support of Settlement - Maryland PDF

WCC Form H-05 Claimant's Affidavit in Support of Settlement - Maryland
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WCC Form C-06 Insurer's Termination of Temporary Total Disability Benefits - Maryland PDF

WCC Form C-06 Insurer's Termination of Temporary Total Disability Benefits - Maryland
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WCC Form H-37 Claimant's Questionnaire - Maryland PDF

WCC Form H-37 Claimant's Questionnaire - Maryland
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WCC Form H-38 Employer's Questionnaire - Maryland PDF

WCC Form H-38 Employer's Questionnaire - Maryland
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WCC Form C26R Request to Enter Appearance of Counsel for Employer/Insurer - Maryland PDF

WCC Form C26R Request to Enter Appearance of Counsel for Employer/Insurer - Maryland
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WCC Form C24R Request to Enter Appearance of Counsel - Maryland PDF

WCC Form C24R Request to Enter Appearance of Counsel - Maryland
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WCC Form H29R Request for Postponement of Emergency Hearing - Maryland PDF

WCC Form H29R Request for Postponement of Emergency Hearing - Maryland
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WCC Form H07R Settlement Worksheet - Maryland PDF

WCC Form H07R Settlement Worksheet - Maryland
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WCC Form C-15R Inclusion Form for Sole Proprietors/ Partners Election - Maryland PDF

WCC Form C-15R Inclusion Form for Sole Proprietors/ Partners Election - Maryland
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WCC Form C90R Request for Document Correction - Maryland PDF

WCC Form C90R Request for Document Correction - Maryland
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WCC Form A-25R Authorization for Disclosure of Health Information - Maryland PDF

WCC Form A-25R Authorization for Disclosure of Health Information - Maryland
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WCC Form H44 Claimant's Consent to Pay Fees and Costs - Maryland PDF

WCC Form H44 Claimant's Consent to Pay Fees and Costs - Maryland
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WCC Form H26R Request for Emergency Hearing - Maryland PDF

WCC Form H26R Request for Emergency Hearing - Maryland
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WCC Form H31R Claimant Request for Change of Address - Maryland PDF

WCC Form H31R Claimant Request for Change of Address - Maryland
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WCC Form WCC H26R Request for Emergency Hearing - Maryland PDF

WCC Form WCC H26R Request for Emergency Hearing - Maryland
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WCC Form H23R Request for Employer Designee to Receive Notice of Employee Claims - Maryland PDF

WCC Form H23R Request for Employer Designee to Receive Notice of Employee Claims - Maryland
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WCC Form H13R Insurer Request for Change of Address - Maryland PDF

WCC Form H13R Insurer Request for Change of Address - Maryland
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