Verify Insurance and Licensure Forms to Submit

The division researches coverage information for callers requesting information for the workers’ compensation insurance providers of employers. This division processes and updates self-insurer information in the NCCI proof of coverage database. Common Board forms that the division will process and provide guidance include: Board form WC-121 Notice of Change of TPA/Servicing Agent, Board form WC-131 Application for Permit to Write Insurance, Board form WC-131a Annual Insurance Update and Board Form WC-26 Consolidated Yearly Report of Medical Only Cases/Indemnity Cases.