Application for Hearing Forms
Here is a list of the forms, with links to PDF files that can be printed, that are required when filing an application for hearing.
Please fill them out completely. Then mail them back to:
Adjudication
Division
Utah
Labor Commission
P
O Box 146615
Salt
Lake City UT 84114-6615
Applications for Hearing
Industrial Accident Claim
Occupational Disease Claim
Medical Care Provider Claim
Applications for Dependant's Benefits and/or Burial Benefits
Industrial Accidnet Claim
Occupational Disease Claim
Summary of Medical Records or Actual Medical Records Supporting your Claim
List of Medical
Providers
Authorization
to Release Medical Records
Appointment of Counsel -
optional