Document Number: WKC-7-E
Description: You may file an application for hearing (WKC-7) if you believe you did not receive all the benefits to which you were entitled. You must submit medical documentation to support each injury date claimed. Be certain to submit all medical documentation since the department will not schedule a hearing until the medical documentation in support of the claim is received.
Submit these two forms with the Hearing Application
WKC-3-E Medical Treatment Statement Supplies and Medication
WKC-16-B-E Physician's Report on Accident or Industrial Disease in Lieu of Testimony
Comments: This form is an electronic pdf template that can be filled out on your computer. We are also providing a PDF (WKC-7) which you can print and complete by hand.
Content Contact: Lynn Weinberger
WKC-7-E (Electronic Version - pdf/203 KB)
WKC-7 (Print Version - pdf/185 KB)
WKC-7 Instructions (pdf/105 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.