This is one of the official Workers' Compensation forms for the state of Vermont.
Vermont Employees Notice of Injury - Workers' Compensation
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How to fill out Vermont Employees Notice Of Injury - Workers' Compensation?
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FAQ
Workers Compensation includes payments to employees and subcontractors deemed to be employees to cover their wages while they are not fit for work, their medical expenses and rehabilitation.
State your name, date of birth, social security number, and date of injury at the very beginning of your letter. Explicitly state that you were on-the-job and that you were injured while performing your duties. Elaborate on the tasks you were performing at the time of your injury. Include as many details as you can.
All injuries, no matter how minor, must be reported within 24 hours of the injury.It must be reported to our workers' compensation department in case the injury becomes worse and needs medical attention in the future. That way, the reporting of the injury will not be considered late by the state.
Temporary Total Disability: For example, if the medical provider has stated that the injured worker has temporary total disability ; it would not be advisable to partake in activities such as mowing the lawn, shoveling snow, or any recreational activity.
Asking You to Give a Signed or Recorded Statement Soon After the Work-Related Accident. Asking You to Sign a Medical Authorization Form. Tell You that Hiring an Attorney Will Cost You Money or Slow Down Your Claim.
Wages or salaries including retroactive wages or salaries. Total cash received by employees for commissions and draws against commissions. Bonuses including stock bonus plans. Extra pay for overtime work-see next section for exceptions.
Get your weekly disability check started, if you're not receiving it already. Maximize your weekly benefit check. Report all super-added injuries. Seek psychological care, when appropriate. Seek pain management care, when appropriate. Don't refuse medical procedures. Be very careful what you tell the doctor.
As a general rule of thumb, you should never discuss anything except the basic facts of the accident, including where it occurred, the date and time it occurred, what type of accident it was, and which body parts were injured.
Before you talk to an insurance adjuster, understand their role. Avoid giving lots of details about the accident or your material damages. Avoid giving a lot of details about the injury. Do not sign anything or give a recorded statement. Don't settle on the first offer. With all that in mind2026