Wyoming Injury Report Form
Description
How to fill out Injury Report Form?
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FAQ
TTD stands for temporary total disability. TTD means that a worker's injuries have left them totally disabled and unable to work, but only for a temporary amount of time.
Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.
Temporary Total Disability benefits are the equivalent of 2/3 of your gross monthly wage at the time of injury, but cannot exceed the Statewide Average Wage for the quarter you were injured. Temporary Total Disability benefits are not taxable.
Wyoming Workers' Compensation Coverage Ongoing treatment like physical therapy for injured employees. Funeral expenses. Disability benefits. Lost wages if your employee is unable to work and needs time off to recover.
In Wyoming, surviving spouses and dependents can receive up to 80% of the average state wage in death benefits for up to 100 months. Families can also be compensated up to $5,000 for both funeral expenses and other death-related expenses.
FAQ Report the injury to your supervisor immediately. Seek medical attention, if necessary. Notify your employer immediately, but no later than 72 hours after having sustained an injury. File a Report of Injury with Workers' Compensation within 10 days. Complete the form in its entirety, preferably with your employer.
Work comp rates for all job classification codes are always expressed as a percentage of $100 in wages. An annual policy is always subject to an audit because it was based on estimated wages and not actual wages. In order to calculate the cost of the policy you only need to multiply each rate with its divided payroll.