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- Click ‘Get Form’ to open the WC-14 in the editor.
- Begin by selecting the appropriate option at the top of the form: 'NOTICE OF CLAIM ONLY', 'REQUEST HEARING / NOTICE OF CLAIM', or 'REQUEST FOR MEDIATION / NOTICE OF CLAIM'.
- Fill in your personal details, including your last name, first name, middle initial, and Social Security Number or Board Tracking Number.
- Provide the date of injury and additional claim information such as birthdate, county of injury, and your address.
- Complete sections for employer and insurer details. Ensure to include names, addresses, and contact information accurately.
- In section B, indicate any hearing or mediation issues by checking relevant boxes and providing dates for benefits if applicable.
- Affirm the accuracy of your information in section C by signing and dating where indicated.
- Finally, certify that you have sent copies of this form to all parties involved as stated in section E.
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