Get the free First Report of Injury (FROI - 148 & R21)

The document provides a comprehensive crosswalk of form types and their definitions for the reporting of workplace injuries and the specifics of various reporting requirements in New York.

How to fill out first report of injury

How to fill out First Report of Injury (FROI - 148 & R21)

1. Obtain the First Report of Injury (FROI - 148 & R21) form from your employer or the relevant authority.
2. Fill in the employee's personal details, including their name, address, and contact information.
3. Provide the date and time of the injury or incident.
4. Describe the nature of the injury and how it occurred in detail.
5. Include any witnesses' names and contact information if applicable.
6. Specify the location where the injury took place.
7. Indicate whether the injury is work-related and any relevant job details.
8. Review the completed form for accuracy and completeness.
9. Submit the FROI form to your employer and keep a copy for your records.

Who needs First Report of Injury (FROI - 148 & R21)?

1. Employees who have sustained a work-related injury or illness.
2. Employers who need to report workplace injuries for insurance purposes.
3. Workers' compensation insurance providers and regulatory agencies.

People Also Ask about

What is the first report of injury form in Ohio?

Injured workers, employers, or medical providers use this form to initiate a workers' compensation claim. The party completing the form should provide as much detailed information as possible. An electronic version of the FROI is available for filing online.

What is the highest paid workers' comp settlement?

$11.3 million workers comp settlement for an injured nanny (California) In 2018, a 29-year-old woman working as a nanny in Los Angeles suffered a catastrophic brain injury while accompanying her employers on a ski trip in Colorado to take care of their five-year-old son.

Where should the first report of injury form be distributed?

The form must be completed in quadruplicate and distributed to the state workers' compensation board, employer-designated compensation payer, the ill or injured party's employer, and the patient's work-related injury chart.

What does froi stand for?

FROI (first report of injury). The FROI is the official start date of the workers' compensation claim. The worker reports the injury to the employer, and the employer files a FROI with the state workers' compensation agency.

What is the doctor's first report of injury form?

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.

What does TBI mean in insurance?

A traumatic brain injury (TBI) can range from a mild concussion to a severe head injury. It is caused by a blow to the head or body, a wound that breaks through the skull (such as from a gunshot), a fall, or another injury that jars or shakes the brain.

What does froi mean in insurance?

First Report of Injury (FROI) The data transaction that occurs early in a workers' compensation claim. The FROI is most commonly the initial report of injury for a claim. A FROI may also be a denial of a claim. Subsequent Report of Injury (SROI)

For pdfFiller’s FAQs

What is First Report of Injury (FROI - 148 & R21)?

The First Report of Injury (FROI - 148 & R21) is a document used to notify relevant parties about a workplace injury. It is critical for initiating the workers' compensation claim process.

Who is required to file First Report of Injury (FROI - 148 & R21)?

The employer or an authorized representative is required to file the First Report of Injury (FROI - 148 & R21) whenever a worker is injured on the job and is seeking workers' compensation benefits.

How to fill out First Report of Injury (FROI - 148 & R21)?

To fill out the FROI - 148 & R21, you need to complete the necessary fields that include details about the injured employee, the nature of the injury, the date and time of the incident, and the circumstances surrounding the injury. Accurate and comprehensive information is essential.

What is the purpose of First Report of Injury (FROI - 148 & R21)?

The purpose of the First Report of Injury (FROI - 148 & R21) is to formally document workplace injuries and ensure that the injured employee can receive appropriate medical care and compensation. It also serves to initiate legal and administrative processes related to the injury.

What information must be reported on First Report of Injury (FROI - 148 & R21)?

The information that must be reported includes the employee's name and contact details, the employer's information, the date and time of the injury, the location of the incident, a description of the injury, and any other pertinent details that could help in processing the claim.