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Board Rule 61b11 Form Wc14a Request To Change Information On A Previously Filed Form Wc14

A party or attorney shall file this form with the Board when requesting correction of a mistake concerning the employee’s name, social security number, date of injury, or county of injury on a previously filed Form WC-14.  A Form WC-14A shall not be used to change an address of record, add additional parties, or additional dates of injury.  A new Form WC-14 shall be filed with the Board to add or amend any information pertaining to the employer, the insurer, the servicing agent or part of body injured, and to add an additional date of injury, hearing issue, or mediation issue.

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Seth Bader
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