Reporting a Claim
The key to reporting claims is early reporting. All work related injuries must be reported to The Workers' Compensation Trust within 24 hours of occurrence. This allows adequate time for early investigation and intervention.
How are claims reported?
By Phone
1-800-506-2655
24 hours a day/7 days a week
What form do we use?
A customized claim form, Employers First Report of Occupational Injury or Disease (PDF), is preprinted with your policy number, company name and address. This information is essential to us when entering the claim.
Types of Claims:
- Lost Time (LT) Claim
- Employee loses 1 or more days from work.
- Medical Only (MO) Claim
- Employee does not lose time from work but has medical treatment.
- Record Only (RO)
- Employee does not lose time from work and does not seek medical treatment - for information only.
How do I complete the form?
Beginning in the upper right hand corner, (Reason for Report: Check one) provide clear, concise information. Complete all boxes. Particular attention should be given to:
- Describe the event(s) which resulted in the injury or disease
- Provide a full explanation as to how the injury occurred based on the information supplied by the injured worker.
- Object causing the injury
- What exactly injured the employee?
- Type of injury; Part of body injured
- What was the injury and to what body part? Specify right or left if applicable. If arm or hand, was it the master?
- The name and address of the first treatment center/physician is needed.
- Date incapacity began
- The first day of full disability based on a calendar week, regardless of the employee's work schedule. This does not include the 1st day of injury.
- Has employee returned to work?
- Please indicate if restricted hours.
- Preparer should never be the employee, always a manager.
All lost time claims must be reported to the Workers Compensation Commission. The Trust will send these reports to the Workers' Compensation Commission on behalf of the employer.
Back to top