Washington Injury Report Form

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

How to fill out Injury Report Form?

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FAQ

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

L&I strives to make filing a claim as easy as possible, and you have options: Online via our FileFast tool. By phone: 1-877-561-FILE (3453) At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you)

Important: Employers by law must report to L&I the death or in-patient hospitalization of any worker (within 8 hours) and any non-hospitalized amputation or loss of eye (within 24 hours) due to an on-the-job injury by calling 1-800-423-7233.

L&I or your self-insured employer must receive your Report of Accident within 1 year of your injury date to file a claim. We must receive it within two years from the date of your doctor's diagnosis for occupational disease claims.

Don't delay. Claims for injuries must be filed within 1 year of the accident. Claims for occupational diseases must be filed within 2 years after receiving written notice from a health-care provider that the condition exists and may be work-related.

The benefit amount is 60 to 75% of the wage you were earning, depending on how many dependents you have. The minimum and maximum L&I can pay is set by the state legislature. You may have better options available - ask your employer if there are other jobs you can do to earn your wage or salary while you recover.

Injuries must be reported within one year. Diseases must be reported within two years after receiving written notice from a doctor that the condition exists and is workrelated. In Washington, you must also file a claim for industrial insurance benefits.

Right to get medical care needed for treatment at no cost. Right to get time loss benefit payment if unable to work for more than 3 days. Right to turn down (decline) ?light duty? work offer unless approved by your doctor. Right to get a permanent partial disability payment if your injury is permanent.

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Washington Injury Report Form