District of Columbia Injury Report Form

State:
Multi-State
Control #:
US-1340837BG
Format:
Word; 
Rich Text
Instant download
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Public form

Description

This form is an example of an injury report form that may be used by a Company in order to report injuries on the job.

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FAQ

DC Workers' Comp Verification The District of Columbia provides a free online tool for verifying workers' compensation insurance coverage. Anyone can search by business name or FEIN. The results will only show the business name and policy number for employers who have coverage in the state being searched.

6. Are employers required to have workers' compensation insurance in DC? Yes, if an employer has one (1) or more employees, the employer is required to have workers' compensation insurance coverage. An employer is also entitled to apply for self-insurance, but must be approved by this office.

All Washington workers must be covered through the State Fund or by a certified self-insured employer, unless they are subject to an exclusion listed in the next section. The information provided in this section is a summary. For a complete description of excluded employment, please see RCW 51.12.

If you are injured on your job, or become ill because of conditions on your job, the D.C. Workers' Compensation Act of 1979 (as amended) entitles you to full medical care for your work-related injury or illness and provides replacement for lost wages.

The average cost of workers' compensation in Washington, D.C. is $53 per month. Your workers' comp premium is calculated based on a few factors, including: Payroll. Location.

Form DWC-7 is a notice to provide injured workers with rights, benefits and contact information.

(1) Electronically: .erisk.dc.gov, this website explains the system and will allow you to report the incident into ERisk, our web-based claims management system; (2) By Phone: call (202) 442-HELP(4357), a representative will assist you in filling out the necessary information.

Sole Proprietors and Partners are included under coverage if they meet the definition of an employee. Otherwise they are excluded. Owners can elect to have coverage. Corporate Officers and LLC Members are automatically included in coverage, but may elect to be exempt.

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District of Columbia Injury Report Form