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Get Pinnacol Assurance First Report Of Injury 2015-2025
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How to fill out the Pinnacol Assurance First Report of Injury online
Filing the Pinnacol Assurance First Report of Injury online can streamline the process of reporting workplace injuries. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and efficiently.
Follow the steps to fill out the form online.
- Press the ‘Get Form’ button to access the First Report of Injury form and open it for editing.
- Begin by entering your policy information. Include the policy number, company name, and location if applicable. Clearly print your name, title, email, fax, and phone number, and note the date you completed the form.
- Proceed to the injured worker information section. Fill in their social security number, date of injury, name, home address, phone number, date of birth, preferred language, marital status, email, occupation, and date hired. Specify the employee status and relevant work details.
- In the accident/injury information section, indicate whether it was a fatal injury and provide the time of injury. Detail the accident's location, representatives notified, witnesses, and how the injury occurred. Include specific activities engaged in and equipment used, as well as the affected body parts and type of injury sustained.
- Next, address the return to work information. Confirm whether the injured worker has returned to work and, if not, provide an estimated return date. Note if this is classified as a lost-time claim.
- Complete the medical provider information by noting where the employee received treatment and provide details about the healthcare provider, including their name, address, and contact information.
- Once all sections are filled out, carefully review the information for accuracy. Make any necessary changes before finalizing the form.
- Save your changes, and you may also choose to download, print, or share the completed form as needed.
Complete and submit your Pinnacol Assurance First Report of Injury online to ensure prompt processing of your claim.
The first thing to do when someone is injured is to assess the situation and provide assistance as needed. Ensure the injured person receives medical help promptly. After addressing their needs, report the incident following your organization’s protocols. Utilizing the Pinnacol Assurance First Report of Injury makes this process easier and more organized.
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