Forms

 
Form Updates
 
Form 2 Application to Resolve a Dispute was updated in late June 2015
 
The Commission has issued a new Form 2, including the following changes:
 
·         New schedule of earnings at Part 5.2
·         Separation of past and future medicals at Part 5.3
·         Pre-filled requirement for inclusion of a Statement of Worker at Part 6.2 (where application filed by a worker)
 
Form 2A Reply to Application to Resolve a Dispute was also updated in late June 2015
The Commission has issued a new Form 2A to  include a new schedule of earnings at Part 4 to mirror the changes to the schedule of earnings made on the Form 2.
There will be a transitional period until the end of July in which the old Forms will be accepted.
 
If you are unable to open the word version please use the PDF format.
 

 

Expedited Assessment

Form 1 - Application for Expedited Assessment MS Word or PDF 
  
Form 1A - Application to Revoke an Interim Payment Direction. MS Word or Pdf
Form 1B - Reply to Application for Expedited Assessment. MS Word or Pdf

Resolving a Dispute 

Form 2 - Application to Resolve a Dispute. MS Word or Pdf
 
 
Form 2 Cover - Multiple Respondents. MS Word or Pdf
Form 2 Cover - Section 162. MS Word or Pdf
Form 2 Cover - Uninsured Employer. MS Word or Pdf
Form 2 Cover - Additional Insurer/Scheme Agent. MS Word or Pdf
Form 2 - supporting documents and information
 
Form 2A - Reply to Application to Resolve a Dispute. MS Word or Pdf
Form 2B - Application to Join a Party to Proceedings. MS Word or Pdf
Form 2C - Application to Admit Late Documents. MS Word or Pdf
Form 2D - Application in Respect of Death of Worker. MS Word or Pdf
 
 
Form 4 - Certificate of Service. MS Word or Pdf
 

Commutation

Form 5A - Application to Register a Commutation Agreement. MS Word or Pdf
Form 5C - Application for Determination to Commute Liability. MS Word or Pdf

Work Injury Management

Form 6 - Application to Resolve a Workplace Injury Management Dispute. MS Word or Pdf
Guide to completing Form 6

Threshold Assessments

Form 7 - Application for Assessment by Approved Medical Specialist. MS Word or Pdf 
Form 7A - Response to application for assessment by an AMS. MS Word or Pdf

Directions for Production

Form 8 - Direction for Production. MS Word or Pdf

Guide to Completing Form 8

Form 8A - Application for Leave to Serve a Direction for Production Outside the State.
MS Word or Pdf
Order
SEPA Notice to Producer
 
Form 8B - Summons to Attend. MS Word or Pdf 

Arbitral Appeal

Form 9 - Appeal Against Decision of Arbitrator. MS Word or Pdf
Guide to completing Form 9

 

 Form 9A - Notice of opposition to appeal against decision of Arbitrator. MS Word or Pdf
Guide to completing Form 9A

 
 Form 9 Schedule - Additional Respondent Insurer Scheme Agent Schedule. MS Word or Pdf

 

Medical Appeal 

Form 10 - Appeal Against a Decision of Approved Medical Specialist. MS Word or Pdf
Guide to completing Form 10
Form 10A - Notice of Opposition to Appeal Against Decision of Approved Medical Specialist. MS Word or Pdf
Guide to completing Form 10A

Work Injury Damages

Form 11 - Direction for Access to Information and Premises. MS Word or Pdf
Form 11A - Certificate of Service for Work Injury Damages Claims. MS Word or Pdf
Form 11B - Application to Cure a Defective Pre-filing Statement. MS Word or Pdf 
Form 11C - Application for Mediation to Resolve Work Injury Damages Claim. MS Word or Pdf
Form 11D - Response to an Application for Mediation to Resolve Work Injury Damages Claim. MS Word or Pdf
Form 11E - Application to Strike Out of Pre-Filing Statement. MS Word or PDF
Form 11F - Opposition to Application to Strike Out of Pre-Filing Statement. MS Word or PDF

Question of Law 

Form 13 - Application for Leave to Refer a Question of Law. MS Word or Pdf
Form 13A - Notice of Opposition to Application for Leave to Refer a Question of Law. MS Word or Pdf

Discontinue 

Form 14A - Agreement to Discontinue Proceedings. MS Word or Pdf
Guide to completing Form 14A
 
Form 14B - Election to Discontinue Proceedings. MS Word or Pdf
Guide to completing Form 14B
 

Assessment of Costs

Form 15 - Application for Assessment of Costs - Schedule 6 before 1 November 2006. MS Word or Pdf
Form 15A - Application for Assessment of Costs - Schedule 6 on or after 1 November 2006 MS Word or Pdf
Form 15B - Application for Assessment of Costs -Schedule 7 MS Word or Pdf

Wages Schedule

Form 18 - Wages Schedule. MS Word or Pdf
Guide to completing Form 18

Miscellaneous Applications

Form 20 - Miscellaneous Application. MS Word or Pdf