INSTRUCTIONS: ALABAMA SUPPLEMENTARY REPORT (WC Form 3)

As part of the process of paying workers' compensation in Alabama after an on-the-job injury, employers may be required to complete the form discussed in this article. This document can be obtained from the website of the Alabama Department of Labor.

Alabama Supplementary Report WC Form 3 Step 1: Indicate whether this form documents a first payment, reinstatement or is amended with a check mark.

Alabama Supplementary Report WC Form 3 Step 2: Enter the employee's name on line 1.

Alabama Supplementary Report WC Form 3 Step 3: Enter the employee's Social Security number on line 2.

Alabama Supplementary Report WC Form 3 Step 4: Enter the name of the employer on line 3.

Alabama Supplementary Report WC Form 3 Step 5: Enter the unemployment compensation number on line 4.

Alabama Supplementary Report WC Form 3 Step 6: Enter the date of the injury on line 5.

Alabama Supplementary Report WC Form 3 Step 7: Enter the date the disability began this period on line 6.

Alabama Supplementary Report WC Form 3 Step 8: Enter the name of the insurance carrier on line 7.

Alabama Supplementary Report WC Form 3 Step 9: Enter the claim number and service number on line 8.

Alabama Supplementary Report WC Form 3 Step 10: Enter the name, address, telephone number, and extension of the office filing this report on line 9.

Alabama Supplementary Report WC Form 3 Step 11: If payment was made, on line A, enter the date of the first check on the first blank line.

Alabama Supplementary Report WC Form 3 Step 12: Enter the amount of the first check on the second blank line.

Alabama Supplementary Report WC Form 3 Step 13: Enter the period covered by the first check on the third blank line.

Alabama Supplementary Report WC Form 3 Step 14: Enter the average weekly wage on the fourth blank line.

Alabama Supplementary Report WC Form 3 Step 15: Enter the compensation rate per week on the fifth blank line.

Alabama Supplementary Report WC Form 3 Step 16: If compensation was not paid within 30 days from the date on which the disability began, complete Part B. Indicate the reason for non-payment on line 13. On line 14, indicate whether compensation was denied and the claimant notified.