How to Complete and File New Hampshire Workers’ Compensation Forms

New Hampshire workers’ compensation forms move through a set sequence after a workplace injury: the employee files Form 8aWCA to notify the employer, the employer files Form 8WC with the state within five days, and the insurance carrier responds within 21 days with either Form 9WCA (accepting and documenting payment) or Form 9WCA-1 (denying the claim). Form 13WCA covers later updates. Every form can be downloaded from the New Hampshire Department of Labor’s workers’ compensation forms page and submitted by mail, fax, or email to the division’s office in Concord.¹

The Forms You Will Encounter

Five numbered forms carry most claims from injury through payment or denial. Knowing which one belongs to which stage keeps a filing from bouncing back.

Form 8aWCA, Notice of Accidental Injury or Occupational Disease, is filed by the employee to report the injury to the employer.
Form 8WC, Employer’s First Report of Occupational Injury or Disease, is filed by the employer with the Department of Labor and the insurance carrier.
Form 9WCA, Memo of Payment of Disability Compensation, is filed by the carrier when it accepts the claim and begins paying benefits.
Form 9WCA-1, Memo of Denial of Workers’ Compensation Benefits, is filed by the carrier when it declines the claim.
Form 13WCA, Employer’s Supplemental Report of Injury, updates the department when the worker’s condition or employment status changes.

All are posted as PDFs on the department’s forms page, and Form 8WC is also available in Word format for easier digital completion.²

Form 8aWCA: Your Notice to the Employer

Form 8aWCA is the one you complete yourself. It is your written notice that a workplace injury or occupational disease happened. You have up to two years from the date of injury to give this notice, but reporting right away protects the claim.³ Long gaps between the incident and your first medical visit give the insurance carrier something to question.

Have this information in front of you before you begin:

Your full name, Social Security number, and home address.
The legal business name and address of your employer.
The date, time, and location of the injury.
Which body parts were injured and how the injury happened. Describe the physical action, not a summary.
The name, address, and phone number of the doctor or facility that first treated you.

The injury description does more work than any other field. Write it so a stranger can picture what happened. “Hurt my back at work” invites follow-up questions. “Lifted a 50-pound box off a shelf and felt a pop in my lower back” gives the carrier something concrete. The body parts and mechanism you write down should match what appears in your medical records. Inconsistencies between the two are one of the fastest routes to a denial.

Form 8WC: What Your Employer Must File

Once you have given notice, your employer has five days from learning of the injury to file Form 8WC with the Department of Labor.⁴ The form captures your date of hire, job title, gross weekly wages, and the employer’s federal identification number, and it starts the insurance carrier’s investigation.

You do not fill out Form 8WC, but you should confirm it was filed. If five days pass without submission, call the Workers’ Compensation Division. Employers submit Form 8WC by mail, fax, or email as described on the department’s online forms page. There is no online portal; the form is downloaded, completed, and sent directly.²

What the Carrier Files Back: Form 9WCA or 9WCA-1

The insurance carrier has 21 days from notification to accept or deny the claim.⁵

Acceptance: Form 9WCA

If the claim is compensable, the carrier begins paying benefits and files Form 9WCA with the department, sending you a copy. The form shows the weekly compensation rate, the date payments begin, and your average weekly wage. Check it. The weekly rate should equal 60 percent of your average weekly wage and cannot exceed 100 percent of your after-tax earnings.⁶ The department updates maximum and minimum rates every July 1.

Benefits do not cover the first three days of disability unless the disability lasts 14 days or longer, in which case those first days are paid retroactively.⁷

Denial: Form 9WCA-1

If the carrier declines the claim, it files Form 9WCA-1 within the same 21-day window and sends you a copy. The denial must state the reason, tell you about your right to request a hearing within 18 months, include the adjuster’s contact information, and provide a narrative explanation.⁵ A denial that arrives without a clear reason, or that misses the 21-day deadline, is worth challenging.

Form 13WCA: Updates After the First Filing

Form 13WCA is the supplemental report the employer files when something changes: you return to work in a limited capacity, your condition worsens, or you reach maximum medical improvement. When the benefit amount itself changes, the carrier files an updated Form 9WCA to document it.⁵

If you go back to work but earn less than your pre-injury average weekly wage because of the injury, the carrier must notify you in writing that you may qualify for temporary partial disability benefits, which equal 60 percent of the difference between the two figures.⁷ To support any status change, have your treating physician prepare a report with the date of your most recent examination, a current diagnosis linked to the original workplace injury, your level of impairment, and any work restrictions.

Either side can also petition the commissioner to review an existing award or denial within four years of the last compensation payment, based on a change in condition, a mistake about the nature of the injury, or other grounds.⁸

Where to Send Completed Forms

Everything goes to the New Hampshire Department of Labor’s Workers’ Compensation Division in Concord. The mailing address is 95 Pleasant Street, Concord, NH 03301.⁹ Fax and email options for Form 8WC are listed on the department’s online forms page.²

Keep copies of every form you submit, on paper or in a folder on your computer. If the department returns something for a missing signature or an incomplete field, your copy lets you fix it quickly. Once a properly completed filing is received, the department assigns a file number that you should reference in every later communication.

Requesting a Hearing

There is no pre-numbered form for a workers’ compensation hearing. You file a written petition to the commissioner at the Concord office.¹⁰ The petition must explain the reasons for the hearing and the specific questions in dispute. A letter that only lists statute sections without describing the actual disagreement will not do.¹¹ Send a copy to the opposing party.

After the petition is received, the commissioner schedules a hearing within six weeks, with at least 14 days’ notice of the date and location. A decision is issued within 30 days of the hearing, and either side may appeal to the compensation appeals board within 30 days of that decision.¹⁰

If your claim was denied, the 18-month deadline to request a hearing runs from the date you received the denial.⁵ Miss it and you lose the right to challenge the denial at the department level. Injured workers representing themselves can reach the Workers’ Compensation Division’s Pro Se Dispute Resolution Coordinator at (603) 271-3587 or WorkersComp@dol.nh.gov for help preparing a hearing request.¹¹

Deadlines to Watch

1
New Hampshire Department of Labor. Workers’ Compensation Forms
2
State of New Hampshire Department of Labor. Employer’s First Report of Injury
3
New Hampshire Department of Labor. Timeframe for Filing a Claim
4
New Hampshire General Court. New Hampshire Code 281-A:53
5
Legal Information Institute. New Hampshire Administrative Code Lab 506.02 – Acceptance or Denial of Claims and Filing of Reports and Payment of Benefits
6
New Hampshire Department of Labor. Injured Employee Benefits
7
New Hampshire General Court. New Hampshire Code 281-A:31
8
New Hampshire General Court. New Hampshire Code 281-A:48 – Review of Eligibility for Compensation
9
U.S. Department of Labor. State Labor Offices
10
New Hampshire General Court. New Hampshire Code 281-A:43
11
New Hampshire Department of Labor. Hearings