Try for free

Wyoming WCD-9 Extraordinary Circumstances TTD Form

Wyoming caps temporary total disability at an accumulated 24 months for the life of a claim unless extraordinary circumstances are medically documented. This version of Form WCD-9 is how a worker applies for TTD past that limit, and its provider certification asks more than the standard form. The certifying provider attests to clear and convincing evidence that the worker remains totally disabled solely from the work injury and should return to work within 12 months.

Who completes it

The worker completes the top section on unemployment, child support and current work, and signs. The certifying health care provider completes the extraordinary-circumstances certification, answering whether the worker remains totally disabled solely from the work injury, can return to gainful work now or within 12 months, and has followed the treatment plan.

Submitting and payment

How to submit it
File 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.
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

  • The certification has five elements: total disability solely from the work injury, not recovered enough for gainful work, expected return within 12 months, no ascertainable loss and reasonable recovery measures taken.
  • Per the certification wording, the 12-month window runs from the date of the first TTD claim made after the 24-month period expires.
  • The form asks whether the claimant has complied with the recommended treatment plan and to explain any noncompliance, since compliance with the treating physician is part of the certification.
  • As on the standard WCD-9, you must have examined the worker within the last 60 days and list specific physical restrictions and the expected TTD dates.

Get the official form

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

Application for Temporary Total Disability Benefits: Extraordinary Circumstances

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.

See how Vero Documents works

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When is the WCD-9 Extraordinary Circumstances form used?

When a Wyoming worker seeks TTD beyond the accumulated 24 months allowed for the life of the claim. The Division's claimant guide says TTD cannot exceed that total unless extraordinary circumstances are medically documented, and this form collects that documentation with the worker's application.

What does the provider certify on the extraordinary circumstances form?

Clear and convincing evidence. Based on an exam within 60 days, you certify that the claimant remains totally disabled solely because of the work injury, cannot yet return to gainful employment, reasonably expects to within 12 months, has no ascertainable loss and has taken all reasonable measures to recover, including following the treating physician's recommendations.

Can extended TTD be certified after ascertainable loss?

The certification states that the claimant does not have an ascertainable loss, meaning permanent impairment that can be measured and will not substantially improve or deteriorate. The form asks the question directly, and the Division's claimant guide says TTD ends when a health care provider determines an ascertainable loss.