First Report Of Injury Form. The employer must also send a. Does the employee speak english?
South Carolina First Report of Injury Form from
Your insurer will report the injury to the department of labor and industry (department), when necessary. Web deaths and serious injuries must be reported to the department within 48 hours. Does the employee speak english? The employer must also send a. Include the sequence of events and name any objects or substance that directly injured the employee or made the employee ill. Send the original form to the claim administrator for the insurance company who provided insurance coverage on the date of the occurrence. Home phone ( ) 5. This can be done via telephone, facsimile or electronic transmission, to be followed by the froi form within seven days of the occurrence. Web the employer is responsible for accurately completing all sections of this form when an employee is injured. It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of.
You may file your first report of injury (form 101), your monthly payment reports (form 107) and a request for extension of time online using the first report of injury management system. Web this form quickly to allow your insurer time to investigate the claim. Web employer's first report of injury or disease document number: Web first report of injury. This can be done via telephone, facsimile or electronic transmission, to be followed by the froi form within seven days of the occurrence. Part of body injured or exposed* 6. Filing online using the first report of injury management system (for insurance companies only) Name (last, first, m.i.) 2. It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of. Does the employee speak english? Home phone ( ) 5.
