Report Accidents and Claim
Doctor claim forms
Accidents:
- Doctor's request for re-opening a claim.pdf
- WAc33 - Banking Details Confirmation for Payment.pdf
- WCl4 - First Medical Report in Respect of an Accident.pdf
- WCl5 - Final or Progress Medical Report in Respect of an Accident.pdf
- WCl20 - Enquiry Regarding Unpaid Medical or Chemist Account.pdf
- WCl31 - Supplementary Report on Injury to Hand.pdf
- WCl52 - Final Report on Eye Injuries.pdf
- WCl221 - Supplementary Report on Injury to Foot.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
Diseases:
- Doctor's request for re-opening a claim.pdf
- WAc33 - Banking Details Confirmation for Payment.pdf
- WAl20 - Enquiry Regarding Unpaid Medical or Chemist Account.pdf
- WCl22 - First Medical Report in Respect of an Occupational Disease.pdf
- WCl26 - Final or Progress Medical Report in Respect of an Occupational Disease.pdf
- WCl53 - Dermatological Report.pdf
- WCl301 - WRULD Final Progress Medical Report.pdf
- WCl302 - WRULD First Medical Report.pdf
- WCl303 - First Medical Report in Respect of Post Traumatic Stress Disorder.pdf
- WCl304 - Final or Progress Medical Report in Respect of Post Traumatic Stress Disorder.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
Employee claim forms
Accidents:
- WAc33 - Banking Details Confirmation for Payment.pdf
- WCl3 - Notice of Accident and Claim for Compensation.pdf
- WCl15 - Sprain Strain Questionnaire.pdf
- WCl32 - Declaration by Guardian or Widow or Widower.pdf
- WCl46 - Burial Expense Account.pdf
- WCl132 - Affidavit by Employee.pdf
- WCl215 - Special Report of Hernia Case.pdf
- WCl236 - Sworn Statement by Employee Late Report of Accident.pdf
- WCl258 - Payment of Lumpsum in Lieu of Pension.pdf
- WCl287 - Application for Supplementary Grant.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
- WG30 - Application for Additional Compensation.pdf
- WG33 - Request for Payment of Pension via Electronic Transfer.pdf
Diseases:
- WAc33 - Banking Details Confirmation for Payment.pdf
- WCl14 - Notice of an Occupational Disease and Claim for Compensation.pdf
- WCl32 - Declaration by Guardian or Widow or Widower.pdf
- WCl46 - Burial Expense Account.pdf
- WCl132 - Affidavit by Employee.pdf
- WCl236 - Sworn Statement by Employee Late Report of Accident.pdf
- WCl258 - Payment of Lumpsum in Lieu of Pension.pdf
- WCl287 - Application for Supplementary Grant.pdf
- WCl305 - Employee Affidavit for an Occupational Disease.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
- WG30 - Application for Additional Compensation.pdf
- WG33 - Request for Payment of Pension via Electronic Transfer.pdf
Employer claim forms
Accidents:
- Letter to CC regarding assault.pdf
- Letter to CC regarding MVA.pdf
- WAc33 - Banking Details Confirmation for Payment.pdf
- WCl2 - Employers Report of an Accident.pdf
- WCl6 - Resumption Report.pdf
- WCl21 - Goggle Questionnaire.pdf
- WCl32 - Declaration by Guardian or Widow or Widower.pdf
- WCl46 - Burial Expense Account.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
- WAc33 - Banking Details Confirmation for Payment.pdf
- WCl1 - Employers Report of an Occupational Disease.pdf
- WCl6 - Resumption Report.pdf
- WCl32 - Declaration by Guardian or Widow or Widower.pdf
- WCl46 - Burial Expense Account.pdf
- WCl110 - Exposure History.pdfWCl110 - Exposure History.pdf
- WG29 - Objection Against a Decision of the Commissioner.pdf
- We can help with reporting occupationally-acquired COVID-19. Clients: Despite the lockdown, please continue to report all your claims to us.
- Claim numbers are being issued by the new CompEasy system. Clients: Please make sure you have received from us and comply with the COVID-19 reporting policy.
- Not all employers are registered and are able to obtain claim numbers. Clients: Please do not feel threatened by demands for confidential claim documents. Send them and the demands only to us.
- The new CompEasy is running but is not yet fully functional. Clients: WCA Workers Compensation Assistance continues to support you during the lockdown. We are available on phone, email or online as usual.
- We are implementing a new telephone system 19 to 25 March 2020. If they occur, please bear with our teething problems.
