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Wyoming WCD-9: Temporary Total Disability Application

Injured Wyoming workers apply for temporary total disability (TTD) benefits on Form WCD-9, and its lower half is the health care provider's certification that the worker cannot return to gainful work. The worker completes the top and brings it to the treating provider, who examines them and files the certification with the Workers' Compensation Division. Providers recertify every 60 days while TTD continues.

Who completes it

The worker completes the top section on unemployment benefits, child support and any current work, and signs. The certifying health care provider completes the certification: diagnosis, work-relatedness, exam and next-appointment dates, planned surgery, light-duty ability, specific restrictions, ascertainable loss and the expected TTD period.

Submitting and payment

How to submit it
The provider files the completed form with the Workers' Compensation Division by mail or fax, as printed at the top. The form warns that an incomplete application may result in denial of benefits.
Who pays
No fee is printed on the form; the visit is billed directly to Wyoming Workers' Compensation with the claim number and medical documentation for each date of service, and in-state providers cannot bill the worker above the Division's fee schedule.

Good to know

  • You certify that you examined the worker within the last 60 days, and the Division's claimant guide says the provider must recertify the TTD application every 60 days.
  • The form asks whether the injury has produced an ascertainable loss, meaning measurable permanent impairment that will not substantially improve or deteriorate; TTD ends when a provider finds one.
  • TTD is capped at an accumulated 24 months for the life of the claim unless extraordinary circumstances are medically documented on the WCD-9 Extraordinary Circumstances version.
  • The first three days of disability are unpaid unless TTD is certified beyond eight days, and benefits end when the worker returns to work in any capacity.

Get the official form

Download the current version from the source each time; forms change without notice.

Application for Temporary Total Disability Benefits

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How often must the Wyoming TTD form be recertified?

Every 60 days. The Division's claimant guide says the health care provider must recertify the TTD application every 60 days, and the WCD-9 certification states that you examined the patient within the last 60 days. Each certification lists the expected TTD period with from and through dates.

Can a worker get TTD while on unemployment in Wyoming?

No. The form cites W.S. 27-14-404(d)(iii): a worker receiving unemployment benefits is ineligible for TTD, and trying to collect both may lead to criminal prosecution. The worker answers and initials questions on unemployment, child support and current work before the provider completes the certification.

What restrictions should I list on the WCD-9?

The form asks for current physical restrictions and says to be specific. It also asks whether the worker can do modified or light duty now, the date they can return to full duty, and whether surgery is anticipated. If light duty is possible, the employer may offer it on the Division's Agreement for Light Duty/Restricted Work.