WCC Vocational Rehabilitation forms can now be completed and/or
submitted online. These forms are accessed via the link
below. Please print/read all instructions before
using or submitting the online forms.
Click here for online forms, instructions,.
WITH THE DIVISION
You may not submit these forms via email or email attachment;
the signed original must be mailed to the WCC at the address
provided on the form (footer). Some PDF forms can be completed
in Adobe® Reader or you may use the typewriter tool if available
in your installed Adobe Reader version. Forms submitted to WCC
must be current and as provided; altered, incomplete,
unauthorized or obsolete forms are returned without processing.
The forms below are Adobe® Reader PDF forms. These forms printed and mailed to the Commission after completion and cannot be used for electronic transmission.
CLICK HERE for Adobe® (Reader) Information and downloads from their web site.
To clarify the regulations and procedures regarding vocational rehabilitation procedures and the use of the VR-04 (Vocational Rehabilitation Dispute), VR-05 (Disputed Provider/Practitioner Selection form) and VR-06 (Agreement on the Propriety of Services & Selection of Practitioner form, please note the following procedures that must be followed in order to comply with the regulations:
When there is agreement as to the selected vocational provider/practitioner and the services to be provided, a VR-06 form must be completed, signed and a fully executed copy sent to all parties (or attorneys) and the Commission. Since the provider/practitioner may not commence providing service until receipt of the form, it is very important that the parties/attorneys expedite the execution and distribution of this form. The Commission will not be issuing an order when there is agreement so the vocational provider/practitioner does not need to wait for an Order from the Commission.
If there is a dispute as to the provider/practitioner, the parties must use VR-05 (Disputed Provider/Practitioner Selection form). Section I of VR-05 is to be completed and the parties must submit the form electronically. An attorney may access form VR-05 through the WFMS subscriber services when logged on. Once the form is submitted electronically, it will be immediately available in the case file. Within 5 days of the filing of Section I, both parties must then print the other party’s VR-05 form and follow the instructions on Section II (the strike process) of this form. Section II of the form must be filed with the Commission by Hand Delivery or Fax ONLY to Regina Brown at 410-864-5251. Once both parties have submitted Section II of the VR-05 (or the 5 days has passed), the Commission will randomly select the provider/practitioner and issue an Order. If a party fails to submit three names or two strikes within the proper time, the Commission will select a provider/practitioner from the opposing party’s list.
If there is a dispute as to the vocational rehabilitation services and emergency assistance is requested, the VR-04 (Vocational Rehabilitation Dispute form) must be used. This form must be submitted electronically. If a request for a hearing is received using the H-24R (Issues form), it will be processed in the normal course and will not be handled in the expedited process indicated in COMAR 14.09.05.12A. Only disputes with vocational rehabilitation issues may be submitted using the VR-04 form. The VR-04 form is also accessible through the WFMS subscriber services when logged on.