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The Notice of Benefit Payment (NOBP) form is used to:

  • notify the employee about payments of permanent partial disability (PPD) benefits and how those PPD benefits are paid (for example, the NOBP reports commencement of periodic PPD benefit payments, completion of periodic PPD benefit payments and a lump-sum payment of PPD benefits);

  • notify the employee of a final benefit payment according to an award, decision or order; and

  • supply the employee with a summary total of all benefits that have been paid or withheld on the claim.

The Department of Labor and Industry (DLI) uses the form to review for compliance with the statutes and rules, to verify calculation of benefits and for statistical data.

A copy must be sent to:

  • the claimant, heirs or dependents;

  • the claimant's, heirs' or dependents' attorney (if represented); and

  • DLI's Workers' Compensation Division.

A copy of this form should also be kept for your file.

Note:  As a good practice, this form should also be sent to the employer.

For more information, see: