Filing a Workers' Compensation Claim: The Forms

February 20, 2019


Rebecca Batisto
Filing a Workers' Compensation Claim: The Forms

If you’re injured at work, the first step to getting workers’ compensation to cover the associated costs is to report your injury to your supervisor. Try to do this as soon as possible after it happens. Companies can be skeptical of the legitimacy of your claim if you wait too long to let them know what happened. Plus, the sooner you report it, the sooner you can start getting benefits.

You can find all of the forms you’ll need on our website, but below is a run down of what each of them is for.

First Report of Injury or Illness.

This form details what happened, when, and how. If you’re going to be out of work for eight or more days due to the injury or illness, the insurance carrier will fill out a portion of the form and report the incident to the Division of Workers’ Compensation. You will likely be asked to explain in your own words what happened, as will your supervisor.

Notice of Action/Change.

If there’s been any change in your claim, this form may be sent to you, your employer, and the Division of Workers’ Compensation. There should be some kind of remarks section that details what those changes are.

Notice of Denial.

You’ll receive this form if the insurance company denies your workers’ compensation claim. Your employer and the Division of Workers’ Compensation will get copies.

Uniform Medical Treatment/Status Report.

Depending on the state you are working in, there will be a physician’s form detailing the relevant treatment. This form is used by your doctor to report to the insurance company the medical status of your claim. It’s very detailed and requires the doctor to determine whether the injury is work-related and whether the injury is more than 50% responsible for your need for treatment. Be sure to ask your doctor for a copy of this form for your own records and bring another copy to your employer.

Employee Earnings Report.

This form allows you to report any income you earn while collecting workers’ comp. The insurance company may require you to send this information to them from time to time, and failure to do so could result in a suspension of workers’ compensation benefits.

Wage Statement.

Your employer will complete this form and send it to the insurance company to report your wages for the thirteen weeks prior to your injury. It’s how the insurance company computes your benefits.

Seeking Medical Treatment:

If your injury is severe or life-threatening, wait until after you’ve seen a medical professional to report the incident and get the forms. However, you’ll need to let the staff at the hospital or clinic know that you are seeing them for a work-related injury.

Even if your injury or illness doesn’t seem serious, you should still see a healthcare professional. Aside from ensuring you’ll recover sooner, the sooner you see a doctor after an incident, the less likely your employer or its insurance company will argue your accident was not work-related.

In an emergency, go to the nearest emergency room. However, if your work-related injury is not serious, there may be laws in your state for getting treated. Some states let you choose the doctor who treats you, but others allow your employer or its insurance carrier to choose for you.

At Normandy Insurance, we can help you find a doctor after you’ve been injured on the job, and even help you file your workers’ compensation claim. If you have any questions at all, please feel free to reach out to us.

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