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NOTICE -The WCIO updated the Injury Description Tables used to reflect specific coding in response to COVID-19.  The WCIO approved the addition of a new Cause Code of 83 for Pandemic and a new Nature Code of 83 for COVID-19. The WCC began accepting these codes effective 4/1/20 and are to be used for the reporting for any claim effective December 2019 or later.

Download The Employer's First Report of Injury (FROI) IAIABC 1A-1 PDF for print (WCC # SF-1).
Mail to:
Maryland Workers' Compensation Commission
10 East Baltimore Street
 Baltimore, MD 21202-1641

  It is filed by the employer or their workers' compensation insurance carrier via our
CompHub portal.
The injured worker will file the Employee Claim Form C-1.

A First Report of Injury (FROI) must be filed by the employer/insurer with the Workers' Compensation Commission.  In accordance with COMAR 14.09.01.02 ' Commission Forms, the Commission only accepts the FROI form prepared by and issued by the Commission, form IA-1 (r 1-1-02).

At this time, please use a hardcopy WCC form SF1[ IA-1 (r 1-1-02)} and mail to us.
 
The fields: Type of Injury/Illness, Date of Death (if applicable) and Initial Treatment must be completed and are required by Maryland Occupational Safety and Health (MOSH), a unit of the Division of Labor & Industry. If these and all other required fields are not complete or on a form other than the Commission's, the FROI will be returned. Please see the complete list of acceptable WCIO Type of Injury/Illness codes


Medical/Provider: Surgeon's Report ( WCC # SF-2)

Open the online MDWCC Surgeon's Report of Injury Form. 

Complete the online form (all fields require input) and submit.

Technical problems or difficulties should be sent to comphubsupport@wcc.state.md.us