WC-701 (2/13) - Notice of Compensation Payments (fill-in form)

The copy of the WC-701 that is sent to the injured worker may be printed as a double-sided form and must be accompanied by a copy of WC-701 Filing Codes that lists the codes used on the front side of the WC-701.

 
If the form involves adjustments to PIWEC or coordination of benefits (e.g., pension, wage continuation, old age social security, unemployment, etc.), the document sent to the Workers' Compensation Agency must be printed as a double-sided form or it will be returned.

 

  Click here for WC-701