Get Wcc Web Form C1

Filling out the WCC Web Form C1 online is an essential step in processing a workers' compensation claim in Maryland. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the WCC Web Form C1.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Complete the claimant's personal information including first name, middle initial, last name, phone number, street address, city, county, state, zip code, social security number, sex, date of birth, marital status, and gross wages per week. Ensure the information is accurate and follows the specified formats.
3. Indicate whether full wages were paid for the day of the injury, and describe your regular work as well as your work at the time of the injury.
4. Fill out employer information including the business name, phone number, and complete address. Confirm if notice of injury was given and describe the nature of the employer’s business.
5. Provide details about the incident, including the location, date of the accident, and how the injury or occupational disease occurred.
6. Complete the claim information, including details about the injured body part, if amputation is required, and whether medical care was requested or provided. Include the name and address of the attending physician.
7. Review all entered information for accuracy. If there is insufficient space for any answer, attach additional pages labeled with the corresponding form field number.
8. Once all steps are completed, submit the form by clicking the submit button. You will then be prompted to print and save the completed form.
9. Sign and date the form in black ink, and read, sign, and date the Authorization for Disclosure of Health Information.
10. Mail or deliver the signed claim form along with the Authorization for Disclosure of Health Information to the Workers' Compensation Commission within 10 days for processing.

Start filling out your WCC Web Form C1 online today to ensure timely processing of your claim.