WCA - WC-701 (1/09) - Notice of Compensation Payments (fill-in form)

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WC-701 (10/09) - Notice of Compensation Payments (fill-in form)

The copy of the WC-701 that is sent to the injured worker must be printed as a double-sided form because the back side contains the descriptions that pertain to all of the codes used on the front side. If the form involves coordination of benefits (i.e., pension, wage continuation, social security, unemployment, etc.), the copy that is sent to the Workers' Compensation Agency must also be printed as a double-sided form or it will be returned.

Click here for WC-701


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