Workers' Compensation Commission


Please complete the fields below and select submit form for WCC approval. No access is available until your application process is completed. All fields marked with an * are required. Additional help with the application can be found HERE.

Email:*User ID, e.g., must be unique to each subscriber
Password:*8-12 Chars with at least 1 number
Confirm Password:*Must match previous field
First Name:*First Name
Middle:Middle Initial or Middle Name
Last Name:*Last Name
Suffix:Suffix, .g. Sr., Jr., III, Esquire
Street Address 1:*Address 1
Street Address 2:Address 2
ZIP:*ZIP Code, e.g. 12345-6789, last 4 digits optional
Work Phone:*Day Phone, e.g. 111-222-3333
Mobile Phone:Mobile Phone, e.g. 111-222-3333