Change workers compensation 2026

1. Click ‘Get Form’ to open the change workers compensation document in the editor.
2. Begin by filling out PART I of the form. Enter your date of injury, name, claim number, phone number, and address in the designated fields.
3. Indicate your current physician's details by providing their name, provider number, address, and phone number.
4. Next, fill in the new physician's information including their name, provider number, address, and phone number.
5. Select the reason for changing your physician from the provided options and add any necessary explanations in the space provided.
6. Answer whether you have been treated by the new physician for your condition(s) allowed in your claim. If yes, provide the date of first treatment.
7. Finally, sign and date the form in the designated area before submitting all copies to your MCO for processing.

Start using our platform today to easily complete your change workers compensation form online for free!