eForm button in eCase

Once logged into eCase, and a case number is entered, claimant attorneys and licensed representatives will see an eForm button.

eForm landing page

After selecting the eForm button, you will be taken to the eForm landing page shown below.

From here, you can start a new eForm, as well as view all drafted and submitted eForms.

The landing page contains eight columns:

1. eForm
2. Status (eForm statuses are Submitted, Rejected, and Draft)
3. Last Saved Date
4. User
5. Submission ID
6. Submission Date
7. Document ID
8. Medium (Displays how the eForm was submitted - WEB, API, FTP)

To start a new eForm, go to the Select a form to submit drop-down list and select RFA-1LC - Request for Further Action by Legal Counsel.

Then select the Start eForm button.

Selecting a request reason

Once a new RFA-1LC eForm is started, the page below will display on the screen. This page shows the request reasons. There are three categories of request reasons:

1. Compensation
2. Medical
3. Other

Note: Some request reasons are conditionally displayed based on the type and state of the case at the time of submission.

Select a request reason, and then click Save & Continue.

Completing the Request Details page

After selecting a request reason, you will be prompted to fill in the request details on the Request Details page. See Request Reason Quick Guide below for important information on request reasons.

In the example below, the request reason "Claimant is not working and not receiving payments" will require you fill in the payment and lost time information and whether an expedited hearing is requested. Select Save & Continue when you are finished.

Submission Progress panel

The Submission Progress panel allows you to keep track of the eForm's progress as you complete each step.

Saving a draft

You can save a draft or exit at any point while filling out the eForm. When you select Exit, the message window below displays on the screen. If you select "Confirm," you are acknowledging that the progress on the current step you are on will be lost and a draft with all previously completed information will be saved.

Adding another request reason

Multiple reasons can be submitted on an RFA-1LC eForm. You may add another request reason once the first request reason has been completed. After saving the request details, a prompt will appear asking if you want to add another request reason. Select Yes to add an additional request reason.

Editing a request reason

To edit request details, select the pencil icon shown on the Submission Progress panel.

Note: You must click the Save & Continue button in order for the pencil icon to appear next to a step in the eForm.

Deleting a request reason

If a request reason was selected in error, select the trash can icon displayed in the Submission Progress panel. This will delete the request reason and return you to the list of reasons.

Upon selecting this icon, you will be prompted to confirm deletion of the record.

Select Delete.

Additional Proposed Findings page

The Additional Proposed Findings page allows you to add findings that are not in dispute and/or request an attorney fee. Choose from the following:

• Establish case (ANCR/ODNCR) as accepted on a First Report of Injury (FROI)
• Establish average weekly wage (AWW)
• Award lost wage benefits as per Subsequent Report of Injury (SROI)
• Attorney or Licensed Representative fee requested (OC-400.1 is required per WCL §300.17(c))

Otherwise, select the No additional proposed findings check box.

Supporting Documentation page

The Supporting Documentation page allows you to reference documents from the case folder or upload supporting documentation for the eForm. Please refer to the Required Document Matrix (MS Excel) for more information on required documentation.

Certification page

Certification may be required for a request reason/additional proposed findings if there was a FROI/SROI submitted on behalf of the primary insurer for the WCB Case ID. It is the responsibility of the claimant's attorney or licensed representative to serve all parties, including any official Board forms uploaded with the eForm submission.

Note: The certification date cannot be the current date.

Attestation page

To submit the eForm, you must accept the Attestation.

Note: The First Name, Last Name, and Organization Name fields should be the information of the attorney or licensed representative assigned to the case, not necessarily the person submitting the form. The Attestation text is shown below.

I affirm that:
(1) my statements are true and correct, and
(2) I am authorized to submit this request, and
(3) this request for Board action is based upon reasonable grounds, has been submitted with my client's consent, and that this form with attachment(s) has been provided to the opposing party(ies), and
(4) I accept that the electronic submission of this form to the Workers' Compensation Board is equivalent to placing my signature on the request.

Fill in the attorney/representative information, and then select the Accept check box. Click Save & Continue when you are finished.

Review and Submit page

Prior to submitting the eForm, you will have a chance to review a draft of your submission. Click the Back button to edit the eForm or delete a request reason.

Upon submission, the system automatically generates a PDF and places it in the case folder. You will be able to view/print/download the PDF from the eForms landing page and via eCase. You can also view submitted eForm details, including submitted status, on the eForms landing page.