New Hampshire Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for New Hampshire Workers' Compensation.

New Hampshire Workers' Compensation Telephone Directory


Workers' Compensation Division - Toll Free: 800-272-4353

Workers' Compensation Division - Mailing address: 603-271-3176

Second Injury Fund: 603-271-3799

Director of Workers' Compensation - Appeal Questions: 603-271-6172

Workers Compensation Claims: 603-271-3174

Vocational Rehabilitation - Toll Free: 800-272-4353

Webmaster: 603-271-8308

Fraud: 800-852-3416

Safety & Training: 603-271-6850

Safety & Training - email address & 2nd number: 603-271-2668

Managed Care: 603-271-3799

School to Work Program: 603-271-0127

Workers' Compensation Coverage: 603-271-3175

WC Coverage: 603-271-2042

Vocational Rehabilitation: 603-271-3328

Self Insurance: 603-271-6172

Employee Leasing: 603-271-2563

Job Modification Reimbursement: 603-271-6172

Dept. of Labor Safety Division: 603-271-6850

Insurance Department Commissioner Christopher Nicolopoulos: 603-271-3945

Businesses: 603-271-2585

Workers: 603-271-3176

OSHA - Concord Area Ofc. - Federal OSHA covers private Employers/Employees in NH: 603-225-1629

Forms & Publications


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Some "Revision Dates" may be displayed as part of the Description.

(8wc) Employer's First Report of Occupational Injury or Disease Form 7/19
(8awca) Notice of Accidental Injury or Occupational Disease 7/14
(13wca) Employer's Supplemental Report of Injury 3/14
(9wca) Memo of Payment of Disability Compensation 6/94
(76wca) Wage Schedule 9/15
(76wca1.xlsx) Supplemental Wage Schedule 7/20
(9wca1) Memo of Denial of Workers' Compensation Benefits 9/15
(75wca1) NH Workers' Compensation Medical Form 6/94
(10wca) Memo of Permanent Impairment Award 10/98
(74wca) Report of Extended Disability 7/89
(taxa) NH Workers' Compensation Task Analysis 9/15
(15wca) Lump Sum Settlement Forms 10/99
(wc3pr1) Release and Settlement of Claim 9/15
(14wca) Authorization for Compensation for Death 10/01
(witness) Authorization to Permit Witness at Medical Examination 9/15
(53wc) Employee's Statement of Employment Status 12/00
(53a) Notice to Suspend Payment of Workers' Compensation Benefits 12/00
(employee-leasing-checklist) Employee Leasing Checklist 10/19
(employee-leasing-initial) Employee Leasing Initial Application 2/16
(employee-leasing-renewal) Employee Leasing Renewal Application 2/16
(employee-leasing-bond) Surety Bond for Employee Leasing Companies N/D
(si1) Self-Insurance Application 2/16
(sigroup) Self Insurance Application-Group 2/16
(gp) Guarantee Proposal 1/92
(si2) Self-Insurance Surety Bond 8/94
(si-q) Self-Insurance Questionnaire 9/15
(si4) Certificate of Insurance 1/92
(si-e) Endorsement 4/96
(si11) Annual Financial Statement 3/75
(si2a) General Purpose Rider 8/94
(ol) Outstanding Liabilities 3/75
(parent-company) Parent Company Agreement 1/92
(actuarial-summary) Actuarial Opinion Summary Sheet 9/15
(sda) Securities Deposit Agreement 1/92
(employee-information) Employee Information Sheet 10/14
(sif1) Application for Second Injury Fund 9/15
(SIF-Request) Request for Reimbursement from the Second Injury Fund 5/13
(SIF-Schedule) Schedule of Reimbursable Payments 5/13
(sif1a) Second Injury Fund Affidavit of Employer Knowledge 3/10
(sif1b) Second Injury Fund Certification by Physician 12/96
(1c) Second Injury Fund Employee Information Sheet (Optional) 1/18
(9wca2) Application for Reimbursement of Paid Adjusted Total Disability 9/15
(9wca2comb) Application for Reimbursement of Paid Combined Earnings 9/15
(ACHEnrollmentForm) State Treasury ACH Enrollment Form for Direct Deposits (ACH Credits)- Only available directly from State Treasury Dept. N/D
(wctpa) Security Deposit Agreement for Third Party Administrator 11/95
(coa) Application for Certificate of Authority 6/19
(noc) Notice of Contract Between Third Party Administrator and Self Insurer 3/19
(tpab) Third Party Administration Bond N/D
(bioa) Biographical Affidavit 3/19
(jobmod) Request for Job Modification Plan Approval 4/18
(vr1) Vocational Rehabilitation Provider Certification Form 6/17
(iwrp) Individual Written Rehabilitation Plan N/D
(vrt) Vocational Rehabilitation Training Agreement N/D
(vr5) Vocational Rehabilitation Closure Form 12/18
(RehabReferral) Rehabilitation Referral Form N/D

Chapter 281 A Workers' Compensation Law

Chapter 404-C Mandatory Risk Sharing Plans

Misc. Related Statutes