All accidents should be investigated to ensure that all pertinent facts are gathered and available if the insurance company has any questions regarding the claim. Establish communication early with the insurance company. This communication should be maintained until the conclusion of the claim.
The law requires an employer to notify the insurance company of an injury within 10 days, no matter how minor the injury. This is done by filing an Employer's First Report of Injury form. Filing the Employer's First Report of Injury is not necessarily an admission that you agree with the facts of the incident. It is a statement that the employee is making a claim. If the employer questions whether an injury is work related, this should be documented and filed with the first report form. Timely filing is critical because the carrier cannot pay compensation benefits or medical bills until it has knowledge of the injury and has the opportunity to evaluate liability. Failure of the employer to file this report in a timely manner may result in penalties against the employer.
Notice of a fatality or an accident in which three or more employees are injured should be given immediately.
By law, the injured worker must notify the employer in writing within four working days of an injury. If the injured employee does not notify the employer within this time frame and the employer posted the proper notice, the worker still may receive benefits, but there may be a penalty for not reporting timely.
Employer's First Report of Injury
The insurer sends the Employer's First Report of Injury to the Division of Workers' Compensation. This report initiates the claim. Your insurance company should provide you with copies of this form and help you complete the form. If you do not know where to report, check with your insurer. Some insurers may have systems for filing by telephone or electronic format. Your insurer will provide you with information on how to file this report.
In most cases, the management of workers' compensation claims in an efficient manner is dependent on the insurer receiving complete, factual information on the Employer's First Report of Injury.
Wages are defined in the Workers' Compensation Act as the money (including overtime) rate at which an employee is paid at the time of injury. Wages include:
- fringe benefits of group health insurance
- housing or lodging, and
- gratuities reported to the IRS.
No per diem payment shall be considered as wages unless it is also considered wages for for federal income tax purposes. The fringe benefits are only computed into the wage replacement when the employer no longer pays the fringe benefit during any time the employee is receiving temporary disability benefits.
Average Weekly Wage
Complete the section of the Employer's First Report of Injury that deals with wages very carefully. The section for Average Weekly Wage (AWW) is used to determine compensation benefits for the employee. An Average Weekly Wage Worksheet can be obtained from your insurer to help you calculate the AWW. The following are examples of AWW calculations:
- Gross monthly pay x 12 ÷ 52
Example: $2000 x 12 ÷ 52 = $461.54
- Daily rate x number of days and partial days worked
Example: $80 x 5 = $400
- Hourly pay rate x number of weekly hours worked
Example: $7.50 x 40 = $300
Where an employee is paid for piecework, tonnage, commission, or any basis other than mentioned above, the total amount earned in the 12 months prior to the injury is divided by the number of pay periods the injured employee was employed during this 12-month period. Where an employee is paid by the mile, calculation of mileage for AWW purposes is limited to the average number of miles per day driven in the 60 working days preceding the injury. This is multiplied by the rate per mile to arrive at a daily wage.
If one of the above methods is insufficient to determine a fair AWW due to the nature of the employment, the Division may determine a fair AWW using another method. Your insurer can help with questions regarding calculation of average weekly wage.
Division of Workers' Compensation | 303-318-8700 |