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Workers' compensation -- Submission of online Medical Request and Rehabilitation Request forms



User information

  • Online forms submission graphicGeneral instructions for completion and submission of Medical Request and Rehabilitation Request forms

    If you have questions about the submission of these forms, call the Alternative Dispute Resolution unit at (651) 284-5032 or 1-800-342-5354.

All data submitted to the Minnesota Department of Labor and Industry via this site shall become part of the file that is maintained by the Workers' Compensation Division for the specified employee's claim. You agree to maintain the confidentiality of the data you submit as required by applicable state and federal laws.

All applicable statutes and rules regarding the filing of Medical Request and Rehabilitation Request forms apply to the forms available electronically from this website. You agree to comply with all of these statutes and rules, including providing copies to all parties, and retaining copies with original signatures, if required by statute or rule.

Data submitted electronically will be accepted as received only during regular DLI business hours, 8 a.m. to
4:30 p.m. (Central Time), Monday through Friday (excluding holidays). Data received after 4:30 p.m. or on a Saturday, Sunday or state holiday will be electronically date-stamped for the next business day that DLI is open for business.

Online Medical Request and Rehabilitation Request forms

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