workers' compensation programs, rehabilitation supports and welfare improvements.
Community
The following English version of claim forms is unauthorized.
If there are any disputes in their interpretation, the Korean version shall supersede them.
Thus we recommend you fill the Korean version of claim forms with reference to the English one.
If there are any disputes in their interpretation, the Korean version shall supersede them.
Thus we recommend you fill the Korean version of claim forms with reference to the English one.
| No | Title | Korean | English |
|---|---|---|---|
| 1 | WCI Claim for Medical Care Benefits & Doctors-in-charge's Medical Opinion | ||
| 2 | WCI Claim for Survivors' Benefits & Funeral Expenses | ||
| 3 | WCI Claim for Temporary Disability Benefits & Injury-Disease Compensation Annuity | ||
| 4 | WCI Claim for Permanent Disability Benefits & Nursing Benefits | ||
| 5 | WCI Claim for (the Advanced Payment of) Temporary Disability Benefits | ||
| 6 | IACI Lump sum Benefits Claim Form | ||
| 7 | WCI Claim for Medical Care Expenses | ||
| 8 | WCI Claim for Transfer to Another WCI Medical Institution, Combined Medical Care Services, Additional Injury-Disease Benefits (Doctor-in-charge's Medical Opinion included) | ||
| 9 | Forms to Apply for Review of Determined Eligibility for WCI Benefits | ||
| 10 | WCI Application for the Adjustment of Review of Determined Eligibility for WCI Benefits | ||
| 11 | WCI Report of Occurence of Work-Related Accidents by a Third Party('s Act) | ||
| 12 | WCI Claim for WCI Benefits Payable | ||
| 13 | WCI Report of Disqualification for Permanent Disability Compensation Annuity and Claim for its Lump-sum Balance | ||
| 14 | WCI Claim for Lump-sum Balance(s) of Survivors' Compensation Annuity | ||
| 15 | WCI Application for the Adjustment of Disability Grade | ||
| 16 | WCI Report of Change in Person Eligible for & Application for Adjustment of Survivors' Compensation Annuity | ||
| 17 | WCI Report of Change in Invalidity Status |