DWC Claim # commnum: Fill out & sign online

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Click ‘Get Form’ to open the DWC Claim # commnum in the editor.
Begin by filling out the REQUEST SPECIFICATIONS section. Check only one box to indicate whether you want to schedule, reschedule, cancel a Benefit Review Conference (BRC), or proceed directly to a Contested Case Hearing (CCH).
In the INJURED EMPLOYEE CLAIM INFORMATION section, provide the employee's name, physical address, insurance carrier's name, date of injury, and employer's business details. Ensure all information is accurate and complete.
For the PARTY REQUESTING TO SCHEDULE section, check the appropriate box indicating who is making the request. Fill in your name, mailing address, and contact information.
In the ISSUE(S) FOR BRC OR CCH section, check applicable boxes for disputed issues and briefly describe each issue. Attach any necessary documentation as required.
Finally, review all sections for accuracy before signing and dating your request. Ensure that you have attached any supporting documents needed for your submission.

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