New Hampshire Claims Forms


Document What It Is When To Use/File
Claim Kit Cove Risk’s exclusive guide for employers and injured workers including forms for proper filing of claims and other necessary information pursuant to New Hampshire Workers’ Compensation Law. Whenever an injury occurs (contains the most commonly used claim forms).
Form 8WC First report of injury.
Secure Form: You may fill out and submit online. For instructions click here
ASAP after the injury occurs.
Form 76 WCA Wage Schedule. Employer must forward to Cove Risk no later than employee’s fifteenth day of disability relating from industrial accident.
Form 13 WCA Employer’s Supplemental Report of Injury. File as soon as possible after date of knowledge of an occupational injury or disease but no later than ten days thereafter. Submit also upon employee’s return to work.