This section contains the rules and forms related to lodgement of an application for conciliation with the Workers’ Compensation Conciliation Service.
The Workers’ Compensation and Injury Management Conciliation Rules 2011 (the Conciliation Rules) support the arrangements for resolving workers’ compensation disputes in Western Australia.
All parties to a dispute need to comply with the Conciliation Rules.
WorkCover WA provides an online lodgement facility for submitting applications for conciliation. Electronically writeable and printable versions of forms for use by unrepresented workers or uninsured employers, or when the online system is unavailable, are below. These forms should not be used to upload information to the online system.
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled. Please note you cannot save content to these forms.
- Form 100 – Application for Conciliation (PDF – 404kb)
- Form 101 – Statement of Social and Financial Circumstances (PDF – 370kb)
- Form 103 – Application for Order for Insurer to Make Payment (PDF – 266kb)
- Form 104 – Notice of Representation (PDF – 244kb)
- Form 105 – Multiple Respondent Form (PDF – 266kb)
- Form 106 – Notice of Discontinuance (PDF – 210kb)
- Form 107 – Memorandum of Consent to Finalising Order (PDF – 242kb)
- Form 108 – Application for Order and/or Assessment of Costs (PDF – 274kb)