Supplemental report 2026

1. Click ‘Get Form’ to open the supplemental report in the editor.
2. Begin by entering the Workers’ Compensation (WC) number and the employee's name at the top of the form.
3. Fill in the 'Date of Injury' and 'Carrier Claim #' fields to provide essential context for your report.
4. Input the employee's Social Security number and employer details as required.
5. Indicate the last day the employee worked and the date they returned to work, ensuring accuracy for benefit calculations.
6. Select whether the employee is receiving full or reduced wages by checking the appropriate box. If reduced wages apply, provide wage information for claims adjuster updates every two weeks.
7. Complete any additional information as necessary, including contact details and who is completing the form (employee or employer).

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