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You can use our online Employee Claim Form to submit and file your claim.

Your claim is filed only after you:

1. Complete the online form

2. Submit the online form

3. Print the online form

4. Sign the printed form pages 1 and 2

5. Mail the 2 signed form pages to the Commission within 30 days

Effective December 10, 2015, your claim filed date is the date you submitted you claim information online when you mail the 2 signed form pages to us within 30 days. Your submitted claim information is deleted if you do not mail the 2 signed form pages within 30 days.

1. Complete the online form

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 form

  • Be sure that all of the information on the form is correct before you SUBMIT.

  • Use the SUBMIT button on the form.

  • 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 information.

3. Print the online form

  • Print the form when prompted.

  • 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 form.

4. Sign the printed form pages 1 and 2

  • Pages 1 and 2 must be signed and dated where indicated by the injured worker, an individual who has the injured worker's Power of Attorney or status as their Legal Guardian.

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 Commission.


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 Commission.

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 shipping/mailing address.