Publications & Forms
Publications
- Nebraska Workers' Compensation Laws and Rules Annotated (published by LexisNexis)
- Rules of Procedure (PDF: 0.5 MB)
- Annual Report (published by fiscal year)
- Statistical Report (published by calendar year)
- Occupational Surveys (published by calendar year)
- Bulletin Since 1937 the Nebraska Workers' Compensation Court has issued its Bulletin to inform the public regarding the application and administration of the Nebraska Workers' Compensation Act (including current legislative changes), as well as information on upcoming training, seminars, and other issues.
- Agricultural Operations & Workers' Compensation (PDF: 0.25 KB)
- Rights & Obligations (PDF: 0.25 KB)
- Rights & Obligations (Spanish) (PDF: 0.25 KB)
- Choosing a Doctor (PDF: 0.25 KB)
- Choosing a Doctor (Spanish) (PDF: 0.25 KB)
- Vocational Rehabilitation Services (PDF: 0.25 KB)
- Vocational Rehabilitation Services (Spanish) (PDF: 0.25 KB)
- Informal Dispute Resolution & Mediation (PDF: 0.25 KB)
- Informal Dispute Resolution & Mediation (Spanish) (PDF: 0.25 KB)
- Information for Claimants Not Represented by an Attorney (PDF: 0.25 KB)
- Fee Schedules (for Medical Services, Hospital and Ambulatory Surgical Centers, Implantable Medical Devices, and Hospital Diagnostic Related Group (DRG))
Forms
Most of the forms below are in Portable Document Format (PDF) and can be completed electronically, then printed and mailed to the Nebraska Workers' Compensation Court, P.O. Box 98908, Lincoln NE 68509-8908. You will need Adobe Acrobat Reader to download these PDF files. Select this link to install Acrobat Reader. You may send questions or comments about these forms to the Email Help Desk.
- Order Form (PDF: 0.25 KB)
- Record Request Form (a secure form that may be completed and filed electronically)
- Informal Dispute Resolution Request Form (PDF: 0.25 KB)
- Petition & Addendum 3 (PDF: 0.25 KB)
- Addendum 3 (PDF: 0.25 KB)
- Release of Liability (PDF: 0.25 KB)
- Form 1: First Report of Alleged Occupational Injury or Illness (PDF: 0.25 KB). Note: Companies that have signed a Trading Partner Agreement with the Nebraska Workers' Compensation Court may use this form only with the court's permission.
- Form 4: Subsequent Report (PDF: 0.25 KB). Note: Companies that have signed a Trading Partner Agreement with the Nebraska Workers' Compensation Court may use this form only with the court's permission.
- Form10T: Termination of Corporate Officer Waiver (PDF: 0.25 KB)
- Form 12: Record of Compensation Insurance (PDF: 0.25 KB)
- Form 12P: Record of Compensation Insurance (Intergovernmental Risk Management Pool) (PDF: 0.25 KB)
- Form 50: Choice of Doctor (PDF: 0.25 KB)
- Form 50: Choice of Doctor (Spanish) (PDF: 0.25 KB)
- Form 63-1: Request for Independent Medical Examiner (PDF: 0.25 KB)
- Form 67-2: Notice of Agreement to Use a Named Independent Medical Examiner (PDF: 0.25 KB)
- Form 62: Independent Medical Examiner Application for Appointment (PDF: 0.25 KB)
- Vocational Rehabilitation Publications & Forms