Vermont Employer First Report of Injury

State:
Vermont
Control #:
VT-SKU-0960
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PDF
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Description

Employer First Report of Injury

The Vermont Employer First Report of Injury is a form that employers must fill out and submit to the Vermont Department of Labor when an employee has been injured on the job. This form is required by the state in order to document the accident and provide information to the workers' compensation insurance carrier. The report is used to help determine eligibility for workers' compensation coverage, and to provide the employer with information about the injury and the necessary steps for filing a claim. There are two main types of Vermont Employer First Report of Injury: the Initial Report of Injury and the Supplemental Report of Injury. The Initial Report of Injury is used to report the initial injury or illness of an employee, and includes information such as the date and time of the incident, the injured employee's name and contact information, a description of the injury or illness, and any witnesses to the incident. The Supplemental Report of Injury is used to provide additional information about the injury or illness, such as the medical treatment that has been received, any changes in the employee's job duties, and the employee's return to work status.

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FAQ

Vermont workers' compensation insurance can help: Pay for medical care if an employee gets hurt or sick from their job. Replace most of their lost wages if they miss work due to an injury or illness from their job. Pay for funeral costs if they lose their life due to a work accident or work-related illness.

How Long Does It Take to Reach a Settlement for Workers' Comp? The entire settlement process?from filing your claim to having the money in your hands?can take around 12-18 months depending on the details of your case and whether or not you have legal representation.

An injured worker's wage paid is 66 2/3%. The weekly payment minimum is $351, 50% of the Vermont state average weekly wage of the workers average wage if less. The weekly maximum is $1,053, 150% of the Vermont state average weekly wage. Maximum period of payments is for the length of the disability.

21 Days calculating in case of FORM 5 If an Employee's Notice of Injury and Claim for Compensation (Form 5) is filed by an injured worker, the employer/carrier shall investigate the claim immediately to determine whether any compensation is due within 21 days.

Vermont workers' compensation insurance can help: Pay for medical care if an employee gets hurt or sick from their job. Replace most of their lost wages if they miss work due to an injury or illness from their job. Pay for funeral costs if they lose their life due to a work accident or work-related illness.

Workers' Compensation A claim for compensation must be made within three years after the injury or death. Any proceedings under the statute are contract claims, which must be commenced within six years of the injury.

The Employer's First Report of Occupational Injury or Illness form is to be completed by an employer or its workers' compensation insurance carrier to notify the Workers' Compensation Commission of occupational injuries or illnesses that result in incapacity for one day or more.

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.

More info

Tell what the injured was doing at the time of the accident. Tell what happened and how it happened.The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin. Description: This form is for the employer to report every work-related injury to its insurance company. If you need assistance completing this form, please contact your insurer for guidance on the best method of reporting work-related accident information. Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. There are presently two options for completing the Employer's First Report of Injury form and filing it with NH Department of Labor. This form will be returned and additional information will be requested if it is not properly completed. The employer is responsible for accurately completing all sections of this form when an employee is injured. TO BE COMPLETED BY INSURANCE CARRIER OR SELF-INSURED EMPLOYER.

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Vermont Employer First Report of Injury