Get Froi 04

Filling out the Froi 04 form correctly is essential for reporting workplace injuries in New York. This comprehensive guide will walk you through each section of the form, ensuring that you provide all necessary information in an efficient and accurate manner.

Follow the steps to successfully complete your Froi 04 form online.

1. Press the ‘Get Form’ button to access and download the Froi 04 form for editing.
2. Begin by entering the employee's full name, including first, middle initial, and last name in the designated fields. Ensure accuracy as this will be critical for claim processing.
3. Provide the date of the injury using the format YYYYMMDD. You will also need the claim administrator's claim number, which should be filled in the corresponding field.
4. Fill in the claim type, ensuring to select 'I - Indemnity' where appropriate, and note the claim administrator’s information as required.
5. Complete the insurer information section, including the insurer's name and FEIN (Federal Employer Identification Number). Ensure this data is correct to avoid delays.
6. Provide details about the nature of the injury, the part of the body affected, and the cause of injury. This will include selecting codes that accurately describe the situation.
7. In the work status section, input details about the employee's employment status and initial return to work date, if applicable. Be specific about any physical restrictions.
8. After you have filled all necessary fields, review the document for accuracy and completeness. Make sure that all information is legible and correctly entered.
9. Finally, save your changes, and use the options available to download a copy, print the form, or share it as required for submission.

Complete your Froi 04 form online today to ensure timely processing of your injury claim.