Workers’ Compensation Injury Forms Packet
The forms identified below can be downloaded for your convenience and will assist you in filing a Workers’ Compensation Claim. All claims must be filed via secure electronic portal at Online First Report. For further assistance, please contact our Bureau by calling (505) 827-2036 or 1-800-510-5093.
NOTE: RMD/WCB will be unable to accept the Workers’ Compensation Claims submitted unless all forms are completely filled out and submitted to the WCB.
Authorization to Release Medical Information
Benefit Explanation Form
Doctor Visit / Modified Work Assignment
Claim Explanation Form
Notice of Accident or Occupational Disease Disablement
Mileage Reimbursement Form
Workers' Compensation Training_2019
Note: You may type directly into these forms. In order to do this, please download the latest Adobe Reader.