New Hampshire Occupational Injury Illness Report

State:
Multi-State
Control #:
US-AHI-275
Format:
Word; 
Rich Text
Instant download
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Public form

Description

This AHI form is used to document an incident of injury or illness that is work-related. The form is to be completed by the employee involved in the incident.

How to fill out Occupational Injury Illness Report?

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FAQ

When communicating with Workers' Compensation, avoid admitting fault or minimizing your injury. Stick to the facts of the incident and refer to your New Hampshire Occupational Injury Illness Report to ensure consistency in your narrative. This approach helps protect your claim and provides a clearer understanding of your situation.

If you are hurt at work, workers' compensation (or "workers' comp") pays your medical bills. It also pays 60% of your lost wages after you miss more than three days of work. Workers' compensation is a type of insurance that all employers MUST provide. It doesn't matter whose fault the injury was.

One of the most frequently most asked questions by employers is whether they have the ability to terminate an injured worker, who has a compensable claim, prior to the lapse of 18 months from the date of the injury. For workers' compensation purposes only, an injured worker can almost always be terminated.

How Do You Write a Demand Letter?DON'T Write War and Peace.DO Highlight Unique Facts About Your Case.DON'T Send the Demand by Certified Mail.DO Differentiate Your Case.DON'T Make a Specific Settlement Demand.DO Demand Policy Limits.DON'T Go Over-the-Top.DO Make Clear the Case Will Not Settle Unless2026More items...

4 Steps for Writing an Effective Accident ReportDate, time and specific location of incident.Names, job titles and department of employees involved and immediate supervisors.Names and accounts of witnesses.Events leading up to incident.Specifically what the employee was doing at the moment of the accident.More items...?

Every incident report you file should contain a minimum of the following:Type of incident (injury, near miss, property damage, or theft)Address.Date of incident.Time of incident.Name of affected individual.A narrative description of the incident, including the sequence of events and results of the incident.More items...?

How to Write a Victim Impact StatementStart with the emotional impact. You can discuss how you felt that day and how you feel now.After covering the emotions, you can transition into your physical injuries and disabilities.Lastly, you'll want to emphasize the financial consequences.

7 Tips for Writing a Demand Letter To the Insurance CompanyStep 1 of 2. 50%Organize your expenses.Establish the facts.Share your perspective.Detail your road to recovery.Acknowledge and emphasize your pain and suffering.Request a reasonable settlement amount.Review your letter and send it!

For any injuries on or after 2/8/94 the compensation rate is calculated using 60% of the average weekly wage but in no event shall the weekly compensation rate exceed 100% of the employee's after tax earnings. This includes calculations for temporary partial benefits and permanent impairment awards.

The 26 weeks preceding the date of injury are used. Up to a 52-week wage schedule can be used. A 52-week wage schedule must be provided and used if requested by the employee or the DOL per Lab Rule 506.02 (e)(4).

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New Hampshire Occupational Injury Illness Report