CO Workers Compensation Commission

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  Application for a Division Independent Medical Examination

  COWC77 $89.00
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  Average Weekly Wage Worksheet

  COWC1A $89.00
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  Dependent’s Notice and Claim for Compensation

  COWC18 $89.00
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  Employer’s First Report of Injury

  COWC1 $89.00
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  Fatal Case – Final Admission

  COWC153 $89.00
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  Fatal Case – General Admission

  COWC151 $89.00
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  Final Admission of Liability (For Injuries On or After Aug. 5, 1998)

  COWC145 $89.00
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  Final Admission of Liability (Prior to Aug. 5, 1998)

  COWC4 $89.00
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  Final Payment Notice

  COWC25 $89.00
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  First Report Transmittal

  COWC106 $69.00
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  General Admission of Liability

  COWC2 $89.00
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  Notice and Proposal of an Independent Medical Examiner

  COWC146 $69.00
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  Notice of Contest

  COWC74 $89.00
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  Petition to Reopen

  COWC37 $89.00
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  Physician’s Report of Worker’s Compensation Injury

  COWCM164 $89.00
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  Supplemental Report of Accident

  COWC12 $89.00