Medical Provider Hearing Forms

Here is a list of the forms, with links to PDF files that can be printed, that are required when filing an Application for Hearing.

Please fill them out completely. Then send them back via fax, regular mail or e-mail to the addresses listed below.

Application for Hearing Medical Care Provider Claim Denial (For Medical Care Providers Only):


We welcome your questions or comments

Utah Labor Commission
160 East 300 South, 3rd Floor
PO Box 146615
Salt Lake City, Utah 84114-6615
(801) 530-6800
Fax:(801) 530-6333
Monday - Friday 8:00 - 5:00
St George Office
1173 South 250 West, Suite 304
St George, Utah 84770
(435) 634-5580
Fax:(435) 673-2621
Monday - Friday 8:00 - 5:00