Workers’ Compensation and Injury Management Conciliation Rules 2011 (External Link)
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. An electronically writeable and printable version of the Form 100 – Application for Conciliation for use by unrepresented workers or uninsured employers, or when the online system is unavailable, is below.
Please note all forms need to be printed single-sided. Forms may be printed and completed by hand or electronically filled.
- 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)