Skip to main content

COVID-19 resources here.  |  Schedule a license exam.  |  DLI offices are closed to walk-in customers.

The Notice of Benefit Reinstatement (NOBR) form is filed by the employer, self-insured employer or third-party administrator to report a reinstatement of wage-loss payments with the Department of Labor and Industry (DLI) after the payments have been previously discontinued by a Notice of Intention to Discontinue Workers' Compensation Benefits (NOID) form (or an order). An NOBR form must be filed when one of the following types of benefits is reinstated:

  • temporary total disability (TTD);

  • temporary partial disability (TPD);

  • permanent total disability (PTD); or

  • dependency (DEP).

It also must be filed by the employer, self-insured employer or third-party administrator to report several different benefit-type changes on the claim, including a change from TPD benefits to TTD benefits or a change from full wage payment (paid by employer) to TTD benefits. 

DLI uses this form to review for compliance with the statutes and rules, and for statistical data.

A copy of this form must be sent to:

  • DLI's Workers' Compensation Division; and

  • the employee -- although service of this form on the employee is not required by statute or rule, it is recommended as an appropriate notification to the employee about the change or reinstatement of their benefits.

For more information, see: