District of Columbia Release of Claims for Personal Injuries by Employee

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US-0630BG
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This form is a release of claims for personal injuries by an employee.
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FAQ

To claim against your employer, you need to be able to prove they acted negligently, causing your injury or illness. Suffering from a work-related injury or illness can be traumatic for even the most capable individuals, especially if the injury was not your fault.

If you get injured, contract a disease or die while working, you or your dependants can claim from the Compensation Fund. The fund pays compensation to permanent and casual workers, trainees and apprentices who are injured or contract a disease in the course of their work and lose income as a result.

If it's an emergency, call 911 or go to an emergency room right away. Tell the medical staff that your injury or illness is job-related. If you can safely do so, contact your employer for further instructions. If you don't need emergency treatment, make sure you get first aid and see a doctor if necessary.

Report the injury to your workers' compensation provider. Ideally, claims should be reported within 24 hours. Some workers' compensation insurance carriers allow you to report claims via phone or a dedicated hotline with nurses on staff. Others provide options for claim reporting via website or even email.

When an injury occurs If it is a serious injury, illness, dangerous incident or death, you must immediately notify SafeWork on 13 10 50 and call your workers compensation insurer within 48 hours.

The general rule is that the employee must be acting within the course and scope of employment for an employer to be held liable. If an employee causes an accident or injury while doing his or her job, acting on the employer's behalf, or carrying out company business, then the employer will usually be held liable.

In a nutshell, your employees are responsible for: Taking reasonable care of their own health and safety. Co-operating with you (their employer) and following instructions. Not putting others in danger.

How does workers' comp work in Washington, D.C.? When a worker is injured on the job or develops an occupational disease, workers' comp provides medical benefits and wage loss benefits. While the employee is unable to work, they receive compensation for lost wages equal to two-thirds of their average weekly wage.

You normally have to make a personal injury claim within three years of the date of accident or the date of diagnosis for your illness. Some people refer to this time limit as the limitation period and it's very important that you don't wait too long before starting your claim.

In most cases, employees are not allowed to sue their employers for a work-related injury, but they are entitled to compensation from the Workplace Safety and Insurance Board (WSIB). In some cases, the WSIB may turn down further compensation for an injured worker for a variety of reasons.

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District of Columbia Release of Claims for Personal Injuries by Employee