Request To Amend Information On A Form WC-14 WC-14a 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the Board Claim Number at the top of the form. This is essential for tracking your request.
3. In the EMPLOYEE section, enter the employee's last name, first name, middle initial, birthdate, and mailing address. Ensure accuracy as this information is critical.
4. Next, provide details about the INSURER/SELF-INSURER including their mailing address and claims office information.
5. In section A (CLAIM INFORMATION), include the date of injury and employee email. This helps in verifying claim details.
6. Proceed to section B (INFORMATION TO BE AMENDED) where you can specify what needs to be amended such as date of injury or employer’s name. Check the appropriate boxes and provide any necessary corrections.
7. Complete section C (AFFIRMATION OF FILING PARTY) by attesting that all provided information is true. Your signature and date are required here.
8. Finally, fill out section E (CERTIFICATE OF SERVICE) confirming that copies have been sent to all relevant parties and include your contact information.

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