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The Notice of Intention to Discontinue Workers' Compensation Benefits (NOID) form is completed by the insurer, self-insured employer or third-party administrator to notify the claimant of a reduction or discontinuance of the following wage-loss benefits due to a return to work at full wages, a return to work at reduced wages or a reason other than return to work (always attach appropriate medical reports):

  • temporary total disability (TTD);

  • temporary partial disability (TPD); or

  • permanent total disability (PTD) (only if there is no previously issued judicial or administrative findings of PT status).

The NOID form also provides the amount of benefits paid on the claim and the claimant's right to an administrative conference.

The form must be completed:

  • within 14 days of the date they received notice the claimant has returned to work at full or reduced wages;

  • at the same time benefit payments are reduced or discontinued for reasons other than return to work; and

  • when denying primary liability on a previously accepted claim when more than 60 days have elapsed since the employer was notified of the injury.

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

A copy of this form must be sent to:

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

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

For more information, see: