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Reporting an injury and filing a claim

  • ​Tell your employer about your work-related injury or illness right away. 
    •  Fill out Form 801 “Report of Job Injury or Illness” and turn it in to your employer. Your employer should send it to its workers’ compensation insurance carrier within five days of your notice. Your employer should provide you this form. 
  • If you go to the doctor after your injury, let your doctor know it is a work-related injury.
    •  Your doctor should help you complete the Form 827 “Worker’s and Health Care Provider’s Report for Workers’ Compensation Claims.” Your doctor should send this to the insurer within 72 hours of your visit to help file your claim. 
    •  Your employer can not pay for medical costs out-of-pocket.
    •  Your doctor should not bill you. 
  • The insurer has 60 days from your employer’s knowledge of the claim to timely accept or deny your claim. You will be notified of the decision in writing. 
  •  If your claim is accepted, the insurer will send a Form 1644​ “Notice of Acceptance” listing the medical conditions accepted.
  •  If your claim is denied, the insurer will send you a letter explaining why it was denied and what your appeal rights are.
You can verify your employer’s insurer by asking your employer or using the online coverage lookup tool.

If you are suffering from an illness caused by your job, you have the same rights to file a workers’ compensation claim. 

Contact a benefit consultant for more information on your rights at 800-452-0288 (toll-free).

If you can’t file directly with your employer because the employer is no longer in business, you’re not employed there, or your employer will not report your injury, contact the Benefit Consultation Unit for more information about your rights at 800-452-0288 (toll-free).


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