Get First Report Of Injury - Pinnacol Assurance

Filing a First Report Of Injury efficiently is crucial for ensuring timely processing of claims. This guide provides clear, step-by-step instructions for completing the form online, tailored for users regardless of their prior experience.

Follow the steps to successfully complete your First Report Of Injury online.

1. Press the ‘Get Form’ button to obtain the form. This will allow you to access the necessary information required for reporting an injury.
2. Begin by filling in the policy details. Input the policy number and the company name in the specified fields. Ensure that the information is accurate to prevent delays in processing.
3. Complete the injured worker information section. Enter the injured worker's name, Social Security number, date of birth, contact details, and occupation. Make sure to verify the dates and contact information for accuracy.
4. In the accident/injury information section, indicate the date and time of the injury, whether it was fatal, and how the injury occurred. Provide as much detail as possible regarding the activity the worker was engaged in at the time of the injury.
5. Specify the injured body parts and the type of injury sustained. This information is key to understanding the severity and type of claim being filed.
6. Fill out the return to work information, indicating if the injured worker has returned to work and the estimated return date if applicable. This is important for tracking potential lost-time claims.
7. Complete the medical provider information, ensuring to document where the employee received treatment. Include details such as the provider's name and contact information.
8. Once all sections are completed, carefully review the form for any errors or missing information. Corrections will facilitate smoother claim processing.
9. Finally, save your changes, and depending on your needs, either download, print, or share the completed form with relevant parties to finalize the claim submission.

Begin filling out the First Report Of Injury online today to ensure a swift reporting process.