Every work injury to an employee causing absence for one day or more or which requires medical services other than first aid treatment must be reported within 7 working days after the injury. Failure to report promptly is a misdemeanor punishable by not more than a $5,000 fine.

Report serious injuries immediately by telephone to your insurer's claims department, then file this form with your insurance company or self-insurer claims office. Upon receipt of this form, check to see that it is complete and accurate. Be sure to list the correct Insurance Company and their SBWC ID number.

Every work injury/illness to an employee causing absence for one day or more or which requires medical services other than first aid treatment must be reported within 7 working days after the injury/illness. Failure to report promptly is a misdemeanor punishable …

Also, includes the “Verification of Partial Unemployment Status” form for employers to compete and return to confirm their employee’s partial unemployment status. This form is due within 5 working days from the date the application is filed.) Workers’ Compensation. WC-1 Employer’s Report of Industrial Injury; WC-2 Physician’s Report

the wc-1 employer's report of industrial injury is an employer's report to the hawaii state department of labor and industrial relation's disability compensation division. this form may also be substituted as an equivalent for the osha form 301 reporting requirement.

The following forms are approved for use in West Virginia workers’ compensation claims.

workers’ compensation benefits. Use the attached form to file a workers’ compensation claim with your employer. You should read all of the information below. Keep this sheet and all other papers for your records. You may be eligible for some or all of the benefits listed depending on the nature of your claim. If you

you must file a form WC-14, Notice of Claim, within one year of the accident with the State Board of Workers' Compensation, 270 Peachtree Street N.W., Atlanta, Georgia 30303-1299.

Claim forms are not available online. Ask your employer for a claim form or contact us if your employer does not have the claim form. HC-7 (a-1) “Reimbursement” type plans (A summary of benefits of the prevalent PPO plan.) HC-7 (a-2) “Service” type plans (A summary of benefits of the prevalent HMO plan.)

WC-1, “Employees’ and Physicians’ Report of Injury” - Please Read Carefully - General Overview: The claim initiation process now involves the filing of two individual forms: WC-1, Employees’ and Physicians’ Report of Injury: To be completed by the injured employee and the medical provider.