Welcome to the Workers’ Compensation Commission’s Online Employee Claim form tutorial. This brief, seven minute video will show you how to complete the online form and explain how to print, sign and mail the form to file your claim.

This video may be paused, restarted, or replayed by using the controls below the video. If you're ready, let's get started.

Before you download the online Claim Form you must install Formatta Filler software. The link to the Formatta Filler download is found in the red bordered box on the Online Claim Form web page. 

When you have installed the software, you will see the "Register Formatta Filler" form. Close or complete and submit the Formatta registration form and return to the Online Claim Form web page. 

You may pause the video at this time to install the software.

Click the “Launch the Form” link located inside the red bordered box.

The blank form will appear and is ready for you to type your claim information.

The entire Claim form is three pages. We'll review it from the last page, page 3 and move forward.  Use the links at the bottom right corner of the form to move from page to page.

Page three of the Claim form is the instructions page. Please take a few minutes to review them before you complete the Claim Form.

Page two is the AUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION.  You do not have to enter any information on this page.

Page one is the part of the form you will use to enter your claim information. 

Form fields 1 through 17 include your PERSONAL INFORMATION such as your name, address and Social Security number. If you do not have this information, enter nine zeros (000-00-0000). You must also attach a brief explanation why you did not provide a Social Security number for us to accept your claim.

Form fields 18 through 32 include EMPLOYER INFORMATION and information about your accident or occupational disease.

Form fields 33 through 50 include CLAIM INFORMATION such as information about your injury and any medical treatment you received at the time of the injury or onset of the occupational disease.

We'll start with the cursor in the first field. As you enter each form field a “bubble tip” appears with useful information about the characteristics of that field such as date format, if the requested information is "required" and any other special instructions.

Form fields for information of undetermined length such as your name or address requires you must use the Tab key or use your cursor to advance to the next numbered field when the information is complete. Information that is predetermined in length, such as date, telephone number or ZIP code will automatically advance to the next field.

Some information fields are indicated by an arrow and are selected from a “drop down” list.

You may pause the video now and complete the Claim Form.

When you have completed and reviewed all of the required information fields on page one, please enter your email address at the bottom so that you can receive an email receipt of your claim information submission. You will see that your name and date of birth as your entered them on page 1 also appear on page 2.

Click the SUBMIT button and your information will be instantly transmitted to the Workers' Compensation Commission. Pop-up dialog boxes will guide you to save a copy of your Claim form to your PC and to print a copy to sign and mail to the Commission.  Note that the submission time now appears next to your email address. 

If you have not completed all of the required fields, an error message will appear to tell you what information is missing.  Please provide the missing information and click the SUBMIT button again.

Do not write on, cross out or otherwise alter the information on the printed Claim Form. 

Be sure to sign and date both pages, including page 2, the AUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION.  Your form will be returned without processing if you fail to sign and date both pages.

Be sure to include any attachments with your Claim form. 

Mail all materials to the Maryland Workers’ Compensation Commission at 10 East Baltimore Street, Baltimore, Maryland, 21202-1641.

You can print additional copies of the saved form for your personal records, your attorney or others who may require a copy. Open the form from its saved location and print it with Formatta Filler.  Use the Print option in the File menu.  Do not resubmit your completed form.

After we receive and process your completed, signed form, you and all parties listed in your claim will receive a Notice of Claim from the Commission via the U.S. Postal Service to the mailing address you have provided on the claim.  Your Claim Number is provided on the Notice.  Please use this number when contacting the Commission about your claim.

You can find more information about the Commission’s claims process on our web site in the General Information menu, selecting Employee Benefits, Claims & Process.  

Once you have your Workers' Compensation Commission Claim Number you can check your claim's status on our web site via the Public Online Services menu, selecting Public Claim Data Inquiry.  You may also contact us by telephone via the numbers provided atop page one (1) of the Claim form. You may use our telephone voice response system or speak with a Public Service representative.  Representatives are available only during normal business hours, Monday through Friday, 8:00 a.m. to 4:30 p.m., excluding state legal holidays.

We hope this presentation has thoroughly explained how to use our online Claim Form.  If you have any additional questions, please use the contact information on the form or our web page. Thank you.