Timeframe for Filing a ClaimWorkers' Compensation 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting the report type: 'Initial', 'Progress', or 'Closing'. Enter the exam date and ensure you fill in the date of injury, injured worker's name, social security number, and date of birth in the case information section.
3. For the initial visit, provide a description of how the accident occurred as narrated by the injured worker. Check if your findings align with their account.
4. Indicate the current work status of the injured worker and document any work-related medical diagnoses.
5. In the plan of care section, detail treatment plans including diagnostic tools, procedures, therapy options, medications, and any necessary supplies.
6. Specify follow-up care and referrals by providing appointment dates and referring provider details. Remember to check applicable boxes regarding maximum medical improvement (MMI) and permanent medical impairment.
7. Finally, ensure that you sign and date the report with your license number before submitting it.

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