Okla. Admin. Code § 810:10-5-2

Current through Vol. 42, No. 4, November 1, 2024

Section 810:10-5-2 - Claim for compensation

(a) A claim for compensation for benefits for an injury, including a cumulative trauma injury and death, or occupational disease or illness, occurring on or after February 1, 2014, shall be commenced by filing an executed notice form with the Commission that includes the employer's Federal Employer Identification Number and the worker's full name and date of birth, and the last five digits of the worker's Social Security number. The following forms, or electronic equivalents, shall be used as appropriate:

(1) CC-Form-3 claim for compensation for benefits for a single event or cumulative trauma injury;

(2) CC-Form-3A claim for compensation for death benefits; and

(3) CC-Form-3B claim for compensation for occupational disease or illness benefits.

(b) A proceeding under 810:15-15-3 to address payment of disputed fees for health services (e.g. physician fees, hospital costs, etc.), vocational rehabilitation or medical case management, shall be commenced by filing an MFDR Form 19 or electronic equivalent. A CC-Form-9 or electronic equivalent shall be filed to request a hearing on an MFDR Form 19 dispute.

(c) Within ten (10) days of the filing of a claim for compensation (i.e. CC-Form-3, CC-Form-3A or CC-Form-3B), the Commission shall mail or send electronically a copy of the claim form bearing the assigned file number to the service agent designated by the self-insured employer, group self-insurance association, or insurance carrier, or as otherwise directed in that Section.

Okla. Admin. Code § 810:10-5-2

Adopted by Oklahoma Register, Volume 32, Issue 23, August 17, 2015, eff. 8/27/2015

Amended by Oklahoma Register, Volume 35, Issue 24, September 4, 2018, eff. 9/14/2018

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/11/2020