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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Employer' section. Enter the employer's name and contact information accurately to ensure proper identification.
In the 'Employee' section, provide the employee's details including their name, job title, and contact information. This is crucial for processing the report.
Next, check all applicable boxes under 'Reason for Report'. This helps categorize the nature of the injury or disease being reported.
Complete the 'Claim Information' section by detailing any relevant claims related to the incident. Be thorough to avoid delays in processing.
Finally, review all entered information for accuracy before submitting. Use our platform’s features to save your progress and make edits as needed.

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What if my employer lied about the first report of injury?

If the employer is lying to the carrier, saying that the employee did not report it when he did, in fact, report it, then that could be considered Workers Compensation fraud, which is a crime. It probably will not mean any extra benefits for the employee.

What is a first injury report?

The Employers First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimants employment and circumstances surrounding the injury or illness are also requested.

Can you get written up for getting hurt on the job?

Yes, there are circumstances where an employer can write you up in a situation where you get hurt. It is unlawful to retaliate against someone for reporting a workplace injury of for exercising their right to workers compensation benefits or for using their protected leave rights to address an injury.

What must the first report of injury contain?

Contents of the First Report of Injury Employee Information: This section includes details about the injured employee, such as their name, address, social security number, date of birth, job title, department, and contact information. It may also include information about the employees supervisor or manager.