Get Form 3 - Oklahoma Workers' Compensation Court

This guide provides clear instructions for users on how to accurately fill out the FORM 3 for the Oklahoma Workers' Compensation Court online. Completing this form is essential for filing a claim regarding an accidental injury and ensures you have the necessary documentation for your case.

Follow the steps to successfully complete your FORM 3 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the name of the claimant, who is the injured employee. Ensure you provide the full name in the format of last name, first name, and middle name.
3. Provide the mailing address, including city, state, and zip code. This information is crucial for correspondence related to your claim.
4. Indicate your occupation in the designated field.
5. Enter your date of birth correctly and check the appropriate box indicating whether your employment agreement was in Oklahoma.
6. Fill in the date of the accident or, if applicable, the date of termination from employment if it pertains to a cumulative trauma injury.
7. State your average weekly wage in the section provided.
8. Specify the nature of the injury by selecting whether it resulted from a single incident or cumulative trauma.
9. Detail the place of injury, including the city, county, and state. Describe the incident thoroughly, mentioning any objects or substances involved.
10. Complete the sections related to social security disability insurance benefits and Medicare eligibility, explaining your circumstances as needed.
11. If applicable, indicate if you are a previously impaired person due to a prior workers’ compensation injury and provide details of your treating physician.
12. Fill in the employer's information, including their FEI number and complete mailing address.
13. If you are represented by an attorney, include the attorney's name, contact information, and OBA number.
14. Finally, review your entries for accuracy, then print and sign the document. Save changes as needed, and you can choose to download, print, or share the completed form.

Begin your process by completing your FORM 3 online today.