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Insert self-insured employer and insurer name, address, phone number, and service company, if any. Report of Job Injury or Illness Workers compensation claim Worker To make a claim for a work-related.

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Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.

Information from the WCD indicates that although you must accept notice of a claim from a worker and report that injury to your insurance company within five days, if the worker needs no medical treatment or is given only first aid, there is no need to notify the insurer.

OWCP considers the supervisor's completion of a claim form as prima facie proof of the worker's status as an employee. The third element is the fact of injury, which has two components: factual and medical.

Oregon's Workers' Compensation Act is no different. If you suffer an industrial injury, statute provides that “notice of an accident resulting in an injury or death shall be given immediately by the worker or beneficiary of the worker to the employer, but not later than 90 days after the accident.” ORS 656.265(1)(a).

By Jodie Anne Phillips Polich, P.C. Oregon has no time limit on how long a worker can collect compensation, or what is more frequently referred to as lost wages, time loss, or temporary disability payments.

The Employer's Report of Occupational Injury or Illness (Form 5020). Every employer is required to file a complete report of every occupational injury or illness to each employee which results in lost time beyond the date of injury or illness or which requires medical treatment beyond first aid*.

Full name of person injured, full name of witness, date, and time of the incident. Name of supervisor. Specific location that the incident occured. Full details of the injury.

Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232