Workers' Compensation Forms

Online Workers' Compensation Claim Submission and Administration

Note: For “Company” enter: JIC

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Workers' Compensation Form General Information

Our online workers’ compensation claims reporting tool icon-export Claims Opening Wizard (iCOW) gives Fund members an easy way to submit workers’ compensation claims (DWC-1’s only). icon-export YCEa is the Fund Administrator’s claim system which can be used to electronically submit Employer’s Wage Statement (DWC Form-3) and Supplemental Report of Injury (DWC Form-6).

Instructions For Specific Workers' Compensation Form Submission

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Access for New Users

New users need to request access to iCOW and YCEa by emailing a completed icon-export YCEa External User Login Account Request Form to icon-export

For Technical Assistance

If you have a user name and need help resetting your password, contact the Help Desk at 800.913.5651 (Monday-Friday 7:00-5:00 CST).

Manual Forms to Submit via Email

If a member cannot use the online claim submission tool, they can also submit completed claims forms by emailing them to icon-export

More Workers' Compensation Information on WC Notices Page

See Other Workers' Compensation Information on WC Notices Page