Utah 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 Utah Workers' Compensation.

Utah Workers' Compensation Telephone Directory


Division of Industrial Accidents: 801-530-6800

Occupational Safety: (801) 530-6918

Fraud Division - Phone, Fax & Email Address: 801-468-0233

Vocational Rehabilitation: 866-454-8397

Labor Commission Main Office - Mailing Address, Phone, Fax & Emailing Address: 801-530-6800

Employers Reinsurance Fund - Mailing Address, Phone, Fax & Email Address: 801-530-6953

WC Self Insured Employers - Mailing Address & Fax: 801-530-6800

Office of Coal Mine Safety - Mailing Address, Phone & Fax: 435-613-5902

Appeals (Adjudication Division): 801-530-6856

Appeals (Adjudication Division) - Southern UT: 801-530-6800

Appeals (Adjudication Division) - Southern UT - In State Long Distance: 800-530-5090

Records Department: 801-530-6844

Coal Miner Certification: 435-613-5901

Outreach & Training Programs: 801-530-6271

UOSH (Compliance) - Mailing Address, Phone, Fax & Email Address: 801-530-6494

UOSH (Compliance) - Second Phone & Email Address: 801-530-6497

WC Coverage Waivers: 801-530-6800

Fraud - Toll Free: 800-955-2210

Department of Workplace Services - Mailing Address, Phone & Email Address: 801-526-9675

Rehabilitation Services (USOR): 866-454-8397

Specialist I: 802-828-2993

Specialist I: 802-828-2206

Specialist I: 802-828-2995

Insurance Department (State): 801-957-9200

Department of Insurance (State) - Toll Free: 800-439-3805

Department of Insurance (State) Acting Commissioner Johnathan T. Pike: 801-957-9320

UOSH Consultation: 801-530-6855

Labor Commission Bureau of Labor Statistics: 801-530-6926

Labor Commission Bureau of Labor Statistics: 801-530-6823

Labor Commission/Industrial Accidents Div./WC Issues: 801-530-6800

Death & Burial Benefit Questions: 801-530-6800

OSHA Utah State Plan applies to all Public & Private Employees - Salt Lake City Ofc: 801-530-6901

Industrial Accidents: 801-530-6800

Industrial Accidents - Toll Free: 800-530-5090

Forms & Publications


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

(122c) First Report of Injury or Illness 10/19
(122) Employer's First Report of Injury or Illness 10/19
(100) Injured Workers' Rights and Responsibilities 10/19
(123) Physician's Initial Report of Work Injury or Occupational Disease 10/19
(020) Wage Claim Assignment Form 7/14
(form043) Attending Physician's Statement 10/19
(form044) Employee's Intent to Leave State / Change Dr. / Hospital 10/19
(102) Application to Change Doctors 10/19
(205) Request for Copies form Claimant's File 10/19
(302) Medical Records - Copies 10/19
(134) Application for Lump Sum or Advance Payment 5/16
(Form089) Employee Notification Denial of Claim 10/19
(441) Insurance Carrier/ Self Insurers Notice of Further Notification of WC Claim 10/21
(130) Insurance Company's / Self Insured Final Report of Injury / Statement of Total Loss 10/19
(141) Initial Statement of Insurance Carrier / Self Insurer with Respect to Payment of Benefits 10/19
(142) Statement of Insurance Carrier / Self Insurer with Respect to Discontinuance of Benefits 10/19
(219) Permanent Partial Disability Statement of Compensation 10/19
(206) Insurer/Employer Initial Reemployment Report for Injured Worker 10/19
(215) Insurer/Employer Request to Waive/Postpone Reemployment Referral 10/09
(239) Insurer's Report on Rehabilitation and Reemployment Efforts for Claimants 10/09
(307) Medical Treatment Provider List - Industrial Accidents 1/21
(308) Authorization to Disclose, Release and Use Protected Health Information Non Permanent Total Disability Claims (10 YEARS OF RECORDS) 6/20
(308.15) Authorization to Disclose, Release and Use Protected Health Information Permanent Total Disability Claims (15 YEARS OF RECORDS) 6/20
(110) Release to Return to Work 5/16
(198) Insurer Request for Extension of Time to Obtain 2nd Dental Opinion 10/14
(221a) Spine Restorative Services Authorization / Denial Form 10/19
(221b) Upper Extremity Restorative Services Authorization / Denial Form 10/19
(221c) Lower Extremity Restorative Services Authorization / Denial Form 10/19
(223) Authorization Request for Medical Procedures 10/19
(310) Request / Appeal for Additional Medical Information 2/09
(350) Emergency Medical Service Provider Exposure Report Form 8/12
(erf) Petition for Reimbursement 8/08
(Form001) Application for Hearing - Industrial Accident Claim 7/18
(Form024) Application for Hearing Medical Care Provider 6/14
(form025) Application for Dependents benefits and/or Burial Benefits - Industrial Accidents Claim 3/12
(form025inst) Instructions for Filling Out Form 025 8/16
(form026) Application for Hearing - Occupational Disease Claim 7/18
(form026inst) Instructions for Filling Out Form 026 3/12
(form027) Application For Dependents Benefits and/or Burial Benefits - Occupational Disease Claim 5/16
(form027inst) Instructions for Filling Out Form 027 8/16
(046) Authorization to Release Labor Commission Records 6/03
(113a) Summary of Medical Record – Industrial Accident 3/10
(113b) Summary of Medical Record – Occupational Exposure 3/10
(151) Dependent's Benefit Order 2/09
(152) Appointment of Counsel 6/16
(402) Application for Hearing For Termination or Reduction of Compensation 3/12
(sub) Subpoena 3/16
(complaint form) Workers' Compensation Coordination of Benefits Untimely Payment Complaint Form N/D
(deathbenguide) Workers' Compensation Guide to Death Benefit Claims 5/17
(dependentapp) Continued Dependent's Benefit Declaration N/D
(form109) Application for Self-Insurance 10/2019
(form215E) Agreement of Assumption and Guaranty of Workers' Compensation 10/2019
(form213E) Self-Insurance Aggregate Surety Bond 10/2019
(form303) Utah Bankruptcy and Insolvency Endorsement 10/2019
(form223E) Renewal Application for Self-Insurance 10/2019

Rule R612-100. Workers' Compensation Rules - General Provisions.

Rule R612-200. Workers' Compensation Rules - Filing and Paying Claims.

Rule R612-300. Workers' Compensation Rules - Medical Care.

Rule R612-400. Workers' Compensation Insurance, Self-Insurance and Waivers.

Chapter 1. Labor Commission Act

Chapter 2. Workers' Compensation Act

Chapter 3. Utah Occupational Disease Act

Chapter 4. Hospital and Medical Service for Disabled Miners

Chapter 6. Utah Occupational Safety and Health Act