Updated Application for Mediation or Hearing, Form WC-104C

Please note the addition of a new “check box” option for users of Form WC-104C, Application for Mediation or Hearing .  This new option can be found in the section that allows for adding another employer.  It remains the goal of The Workers’ Compensation Agency and the Board of Magistrates to continue our efforts to streamline operations and procedures to better serve our customers.

The change to Form WC-104C is a new check box option titled, “Add non-employer entity.”  Until this addition, petitioners could add another employer, but found it difficult to simply add another party to the case.  Utilizing this new check box will allow users to more easily indicate their intentions, and aid in processing.

Please begin using this new form immediately.  If you have form templates created by outside entities, please have your templates updated, or simply utilize the form from the WCA website for future submissions.