PDF-IA-1 WORKERS COMPENSATION - FIRST REPORT OF INJURY OF ILLNESS

Employer Name Address Including Zip CarrierAdministration Claim Number Report Purpose Code Jurisdiction Jurisdiction Claim Number Insured Report Number KY Location . Northern Rockies Incident Business Committee. 2015. 1. Overview. Overview of the . Federal Employee Compensation Act Program. Define Roles and Responsibilities. W. hat . happens when an employee . is injured or fall ill on the job. Montana was one of the first states in the country to enact workers’ compensation legislation.. Codified at Mont. Code Ann. § 39-71-101, et seq.. 39-71-105. Declaration of public policy.. (1) An objective of the Montana workers’ compensation system is to provide, without regard to fault, wage-loss and medical benefits to a worker suffering from a work-related injury or disease. Wage loss benefits are not intended to make an injured worker whole but are intended to assist a worker at a reasonable cost to the employer. . Return to Work Programs. Employer at Injury. Vocational Assistance. Preferred Worker. The Workers´ Benefit Fund (. WBF). a . payroll assessment calculated on . the basis . of hours worked by all paid workers, owners, and officers covered by workers´ . /\. Summit. Post-Injury Procedure. Injury occurs . Assess the situation. How severe is the injury?. First-Aid Only. Minor/Moderate injury Requiring Treatment. Severe – requiring immediate and significant treatment.. Incident Management Team. Objectives. Overview . of the Federal Employees’ Compensation Act (FECA. ) and the Office of Workers Compensation Programs. Conditions of coverage. Claim types . Claim submission process and responsibilities. August 9, 2011. Table of Contents. Basic Workers’ Compensation Rules. The Cost of Accidents. Benefits to Employees. Definitions and Provisions. Types of Injuries Covered and Excluded Claims. Choice of Physician. Employee Reporting Procedures. What should an employee do if he/she is injured on the job?. . Call 911 for all emergencies that result in serious bodily injury, and seek treatment at the nearest emergency room.. Tim Tucker. Washington Affairs Executive. Virginia Workers’ Compensation Commission. Educational Conference. October 18, 2018. Session Overview. Evolution of the Workplace. Workplace Demographics. Nature of Work. If you are injured Report any injury to your supervisor as soon as possible, no matter how minor it may appear. You may lose the right to workers! compensation benets if you do not make a timely rep OCR 100This form can be used in lieu of the MIOSHA Form 301 Injury and Illness Incident Report It is one of the first forms you must fill out when a recordable work-related injury or illness has occur 4 WCB Case if knownDoctors Initial Report Use this form to report the first time you treated the patient To report continued treatment use Form C-42 To report permanent impairment use Form C-434 Dia Page 1 Effective September 23 2002Injury Description Codes Cause of Injury Code Narrative Description I Burn or Scald Heat or Cold Exposures Contact With 01 Chemicals 02 Hot Objec Claims reporting – Forms and timing. Presented by:. Deep East Texas Self Insurance Fund. Tim White – White Espey, PLLC. Christine Dextraze – TRISTAR Risk . Management. March 31, 2022. Agenda – Workers’ Compensation 201. Human Resource Services. Michele Wheeler. Workers Compensation Manager. Reporting Requirement. Per Montana Statute all injuries must be reported to your immediate supervisor within 30 days.. Failure to report the injury within 30 days may result in a denial of the claim..