Legislative amendments effective October 1, 2007 will result in the implementation of new forms and emergency regulations for the filing of claims.
The Employee Claim Form (MD WCC Form C1) will consist of three (3) pages. Page one will be substantially similar to the current form in use. Page two will consist of an Authorization for Release of Health Information. Page three will contain various notices and instructions relevant to the completion of the new form. Any claim filed on or after 12:01 am October 1, 2007 must be filed with the Commission on the new Employee Claim form C-1 including the Authorization for Release of Health Information on Page 2 .
The new form will be available for on-line submission on October 1, 2007. (it must be printed, signed and mailed to the Commission), however, the form may not be printed from the website to be filled out by hand and mailed. Only specially printed (hard copy) original forms obtained from the Commission will be accepted for filing if completed by hand. Employers and insurers requiring large quantities of Form C1 are encouraged to pre-order the form from the Commission in advance of October 1, 2007.
Please email your preorder request utilizing this link (you must specify the quantity required, shipping address and contact information) . Due to the volume of requests, you may not receive your entire order in the initial shipment. PLEASE NOTE: The form will also be available for electronic submission via the Commission's website on October 1, 2007, but the form must still be submitted online, printed and mailed and will not be considered filed until it has been received by the Commission in hard-copy.