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How to fill out the Nysif Efroi online
The Nysif Electronic First Report of Injury (eFROI) is a necessary document for filing a workers' compensation claim online. This guide provides clear and concise instructions to help users accurately complete the form and expedite their claims submission.
Follow the steps to successfully complete the Nysif Efroi online.
- Press the ‘Get Form’ button to obtain the form and access it within your preferred online platform.
- Begin by completing the policyholder information section. Enter the policyholder name, policy number, industry type code, phone number, and mailing address, including city, state, and ZIP code.
- Next, provide the claimant information. This involves inputting the claimant's name, address, city, state, phone number, ZIP code, social security number, gender, date of birth, and job title. Ensure that you confirm whether the employee provided notice of the accident or illness, including details of to whom this notice was given.
- In the employment information section, input the date of hire, the claimant’s gross average weekly wage, and usual days worked. Additionally, indicate the time the claimant started work on the incident date, the date they stopped working due to the injury, and the last day they were paid in case of lost time. Note whether the employer is continuing to pay the claimant while they are out of work and if the claimant has returned to work.
- Proceed to detail the accident/illness and injury information. Record the date of the accident or illness, describe what the employee was doing at the time of the injury, and how the accident occurred. Clarify the accident location and whether it coincides with the policy location.
- Further in this section, define the nature of the injury, the body parts involved, and the cause of the injury. Specify if the employee had any earlier work-related injuries to the same body part. Confirm if the injury resulted in death or involved an object or a licensed motor vehicle.
- If applicable, respond to the additional questions for volunteer firefighters or ambulance workers regarding protective equipment. Provide medical provider details if medical care was received, including the name and address of the care provider.
- Finally, after completing all sections, review all input for accuracy. Users can save changes, download the form, print it, or share it as necessary.
Start filling out your Nysif Efroi online today to ensure a smooth claims process.
The NYSIF is a state fund designed to provide workers' compensation insurance and disability benefits to New York workers. It supports businesses by ensuring compliance with state insurance requirements while offering essential coverage for employees. With Nysif Efroi, you can manage each aspect of the claims process, reinforcing your commitment to your workforce's safety and well-being.
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