New Hampshire Report of Occupational Injury or Illness

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Multi-State
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US-427EM
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Description

This form is used to document information concerning an injury or illness suffered by an employee on company property.

How to fill out Report Of Occupational Injury Or Illness?

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FAQ

To fill out a report for a hand injury, provide specific details about how the injury occurred, including the task you were performing at the time. Document the extent of the injury and any medical attention received. Use the New Hampshire Report of Occupational Injury or Illness as a guide to structure your report clearly and effectively.

NCCI produces both intrastate and interstate experience rating modifications. NCCI provides Proof of Coverage data to the State of New Hampshire, Department of Labor, Workers' Compensation Division.

The employer must report a workplace injury within 7 days or within 14 days of finding out that you have an occupational disease.

Your employer is legally responsible for reporting your injury on duty to the Compensation Fund within seven (7) days of receiving notice from you and within fourteen (14) days when it is an occupational disease as well as submitting the necessary forms and documents.

This is a list of the Non-NCCI States:California.Delaware.Indiana.Massachusetts.Michigan.Minnesota.New Jersey.New York.More items...

If the employee is booked off due to an IOD for 4 days or longer, but less than 3 months, the employer must pay the injured employee at a rate of at least 75% of his earnings, from the first day, until the employee returns to work.

There are 11 Independent Rating Bureaus in the US that were created by their state-specific statutes. These states are: California, Delaware, Indiana, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, and Wisconsin.

DEFINITION OF INJURY ON DUTY /OCCUPATIONAL DISEASE (IOD /OD) An unexpected occurrence, at a specific date, time and place and arising out of and in the course of the employee's employment, resulting in personal injury or death, or when an occupational disease is contracted due to exposure at the workplace.

New Hampshire law requires employers to provide workers' compensation insurance. The primary responsibility for obtaining workers' compensation insurance rests upon employers who must apply for and obtain coverage prior to the hiring of any employee.

How do I get this service? When a worker gets injured or contracts a work related disease he or she must report the injury or the disease to his or her employer immediately or within 10 days of incurring such.

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New Hampshire Report of Occupational Injury or Illness