CURRENT COURT FORMS
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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
the
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 NOT 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. In addition all Court Forms are available from the Court's Records Department. To obtain blank forms from the Court, please fill-out the 'Request for Court Forms' and mail to:
Workers' Compensation Court
Records Department - Forms Request
1915 N Stiles Ave
Oklahoma City OK 73105-4918
| Form No. | Title | Form Color | File |
|---|---|---|---|
| 1A | Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees. 8/11 | Peach | |
| 1A | A Viso E Instrucciones Para Todos Los Empleados Y Empleadores Sobre La Compensacion Para Los Trabajadores De Oklahoma. 08/11 | Tan | |
| 1B | Employer's Application for Permission to Carry Its Own Risk Without Insurance. 2/2012 (three page form) | ||
| CS-APPENDIX | Compromise Settlement Appendix 1/12 | ||
| CCS | Certificate to Compromise Settlement. 8/11 | ||
| CSD-337 | Compromise Settlement. (Death Claim) 1/12 | ||
| CS-339A | Compromise Settlement. 8/11 | ||
| CS-339B | Compromise Settlement - Agreement Between Employer and Employee as to Fact with Relation to an Injury and Payment of Compensation. 1/12 | ||
| 2 | Employer's First Notice of Injury. 8/11 | ||
| 3 | Employee's First Notice of Accidental Injury and Claim for Compensation. 8/11 | Yellow | |
| 3A | Claimant's First Notice of Death and Claim for Compensation. 8/11 | Gold | |
| 3B | Employee's First Notice of Occupational Disease and Claim for Compensation. 8/11 | Gray | |
| 3F | Employee's Notice of Claim for Benefits From Multiple Injury Trust Fund. 8/11 | Tan | |
| 4 | Treating Physician's Report and Notice of Treatment. 8/11 | ||
| 5 | Physician's Report on Release and Restrictions. 8/11 | ||
| 7 | Designation of Service Agent. 10/09 | ||
| 9 | Motion to Set for Trial. 1/12 | ||
| 10 | Answer and Pretrial Stipulation Offered by Respondent. 8/11 | Green | |
| 10A | Respondent's Response to Claimant's Form-A Application For Change of Physician. 8/11 | Blue | |
| 10M | Response to Request for Payment of Charges for Medical or Rehabilitation Services. 8/11 | Ivory | |
| 13 | Request for Prehearing Conference. 8/11 | ||
| 17 | Physician Disclosure Statement. 12/11 | ||
| 18 | Request For Court Administrator Review of Disputed Medical Charges. 2/12 | Orchid | |
| 19 | Request for Payment of Charges for Health or Rehabilitation Services/ Notice of Appeal of Court Administrator Order. 2/12 | ||
| 20 | Proof of Loss (Death Claim). 8/11 | Blue | |
| 93 | Application and Order for Leave to Withdraw as Attorney of Record. 8/11 | ||
| 99 | Pauper's Affidavit. 8/11 (two-sided form) | ||
| 100 | Claimant's Application and Order for Dismissal. 8/11 | ||
| 463 | Application for Physicians Seeking Appointment as an Independent Medical Examiner. 2/06 | ||
| 626 | Application for Medical Case Manager 8/11 | ||
| 862 | Application for Vocational Rehabilitation Evaluator. 8/11 | ||
| A | Claimant's Application for Change of Physician and Request for Hearing. 8/11 | ||
| A - Order | Order for Change of Treating Physician. 8/12 | ||
| 926 | Mediator Application 05/12 | ||
| NPT | Request for Nunc Pro Tunc | ||
| Copy Request Form. 9/11 | |||
| Vendor Maintenance Form 08/10 | |||
| Request for Independent Medical Examiner, Rehabilitation Evaluator or Medical Case Manager 09/07/11 | |||
| Prior Claims Request Form 4/12 | |||
| Copier Charge Account - Subject Line Detail Authorization Form |
