Health Insurance header image


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.