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The law requires the employer to furnish the injured employee a copy of this report. WC-1 EMPLOYER'S REPORT OF INDUSTRIAL INJURY. CASE NUMBER. USING THE NEW FORMS. After that date, all forms received by the Board will be returned. WC-1, Employer's First Report of Injury (Revised 2017). WC- the New Mexico Workers' Compensation Fee on Form WC-1 (pursuant to Section 52-5-19 NMSA 1978, as amended in 1992). Each employer who receives a Rev. 08/2010. STATE OF NEW MEXICO. TAXATION AND REVENUE DEPARTMENT. WC-1 - WORKERS' COMPENSATION FEE FORM. Mail to: Taxation and Fill State Of New Mexico Form Wc 1, download blank or editable online. Sign, fax and printable from PC, iPad, tablet or mobile with PDFfiller ? Instantly ? No 1. Instructions for Completing the. First Report of Injury. Please read all pages. This form is “fillable. When you open the form, click in the “Employee's Name” box (field), complete the information, and use the WC 1 Rev 01/06. COLORADO and file Form WC-1. Employers covered by requirement are all those having three or more employees, including out-of-state employers having New. Mexico Form OIC-WC-1. West Virginia Workers' Compensation. Employees' and Physicians' Report of Occupational Injury or Disease. PLEASE PRINT OR TYPE. WC-1. REVISION . 07/2011. 1. EMPLOYER'S FIRST REPORT OF INJURY B. INCOME BENEFITS Form WC-6 must be filed if weekly benefit is less than Form OIC-WC-1 West Virginia Workers' Compensation Section I Employee's Claim Information. Insurer: Third-Party Administrator: 1. Name: (Last):. (First):.
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