First Report of Occupational Injury or Disease
The employer must complete and file with their workers’ compensation insurance carrier a first report of injury within 10 days of notice of a work accident resulting in personal injury.

Agreement
Carriers and self-insured employers must use this form to report to OWC payment agreements with injured workers.

Agreement for Compensation for Death
Carriers and self-insured employers must use this form to report payment agreements for a work injury involving an injured worker’s death.

Receipt
Carriers and self-insured employers must file this form to report to OWC when the injured worker receives payment for any item covered in the Workers’ Compensation Act (19 Del.C. Ch. 23).

Petition for Commutation
Carriers and self-insured employers may file this petition for a hearing where the Industrial Accident Board (or a hearing officer) decides whether or not the parties may commute payments for a case.

Petition to Determine Additional Compensation Due
Injured workers may file this petition for a hearing where the Industrial Accident Board (or a hearing officer) decides issues involving work injuries already accepted as compensable.

Health Care Providers may file this petition for a hearing where the Industrial Accident Board (or a hearing officer) decides issues involving injured workers whose 1) work injuries are already accepted as compensable, and 2) unpaid medical treatment does not fall under one of the workers’ compensation health care practice guidelines. Except for sole proprietors, healthcare providers must file petitions through an attorney, who is also a member of the Delaware State Bar Association.

Petition to Appeal a Utilization Review
Parties may file this petition to appeal a utilization review determination as part of the new Delaware Workers’ Compensation Health Care Payment System (HCPS). Parties must file this petition within 45 days of receipt of the UR determination, pursuant to 19 Del. C. Section 2361(c).

Petition to Determine Compensation Due
Injured workers may file this petition for a hearing where the Industrial Accident Board determines the compensability of a work injury.

Petition to Determine Compensation Due to Dependents of Deceased Employee
Injured workers may file this petition for a hearing where the Industrial Accident Board determines the compensability of a work injury involving the employee’s death.

Petition to Determine Disfigurement
Injured workers may file this petition for a hearing where the Industrial Accident Board (or hearing officer) determines the amount of compensation for disfigurement, pursuant to 19 Del.C. §2326(f).

Petition to Review Compensation Agreement
Carriers and self-insured employers may file this petition to terminate injured workers’ benefits.

Pre-Trial Memorandum
Petitioner’s counsel shall complete this form and send it to the respondent’s counsel. The respondent’s counsel shall complete the respondent’s portion and return it to the petitioner’s counsel who shall file it with the Department and send a copy to the respondent’s counsel. (Board Rule No. 9)

Eligibility Certification Form

Request for Copy of Document

Related Topics:  Forms, Workers' Compensation