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What information is entered into Block 4 on the CMS-1500 claim for a workers' compensation case? 1) Name of patient's employer. 2) Patient's name. 3) Workers' compensation insurance carrier.

Form LIBC-344 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

Call the nearest OSHA office. Call the OSHA 24-hour hotline at 1-800-321-6742 (OSHA).

What is the most common method states use to determine wage-loss benefits? They compensate employees based on a percentage of their salary before the injury.

A. Report the injury to your employer by telling your supervisor right away. If your injury or illness developed over time, report it as soon as you learn or believe it was caused by your job. Reporting promptly helps prevent problems and delays in receiving benefits, including medical care you may need.

Supervisor Responsibilities When an injury does occur, supervisors are expected to directly respond and assist the injured employee in receiving the appropriate medical treatment. A supervisor, should never be in a situation where one of their employees is injured and they don't know about it.

Report the Injury If you are injured at work, you should immediately (or as soon thereafter as possible) report your injury to your employer or immediate supervisor. Your employer is required to fill out a form, sometimes called a "First Report of Injury," for every injury which occurs in the workplace.

The employer is required to file an Employer's First Report of Injury or Illness [DWC FORM-001 Rev. 10/05] with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.