You may no longer submit this form to the Office of Workers' Compensation. Please complete the form and send to your insurer. (RS: )
Any time payment begins or payment is modified or suspended, the LWC-WC-1002 (Notice of Payment) must be completed by the employer, insurer, or self-insurer and a copy sent to the injured employee. A copy should be sent to the Office of Workers' Compensation Administration (OWCA) within ten days of the effective date of the form. Items with asterisks must be completed or the form will be returned.
Download Form 1002 (PDF) (LWC-WC-1002 Rev. January, 1998)
(This form is semi-interactive and may be filled out online.)