1. Complete the online
The Online Employee Claim
Form C-1 must be completed and submitted online - on
your Windows PC - using Formatta Filler software. You
must be able to install software on your PC. Formatta
Filler does not work with Google Chrome; Formatta Filler
works with current, supported versions of Internet
Explorer or Mozilla Firefox.
2. Submit the online
Be sure that all of the
information on the form is correct before you
Use the SUBMIT button on
If any required
information is not completed, the form provides an
error message. Complete the required information.
When you include a valid
email address on the form you will receive an email
confirmation about your submission with additional
3. Print the online
Print the form when
Save the form to a
location on your PC, like your Desktop or Documents.
The submitted form must
be printed on white paper.
A submitted form shows a
date stamp at the bottom of the printed form.
Do not alter the printed
form (no corrections or changes of any kind).
Altered forms are returned.
Do not print a blank
form to complete offline by hand or reuse a saved
4. Sign the printed
form pages 1 and 2
5. Mail the 2 signed
form pages to the Commission
Mail the original,
completed, signed form to – Maryland Workers’
Compensation Commission, 10 East Baltimore Street,
Baltimore, Maryland, 21202.
Photocopies of the form
are not accepted.
PagePage 3 is information
for the injured worker and is not mailed to the
You can check the status
of your claim via the
Public Claim Data Inquiry on our web site after you
receive the Notice of Claim in the mail. Normal
processing takes about a week (5-7 business days) after
you have mailed the completed, signed form to the
If you cannot use
the online Employee Claim form -
email your request for a paper form to be sent to you
via the U.S. Postal Service by providing your