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The document details changes made to the First Report of Injury (FROI) form and the EDI implementation guide by the Department of Labor and Industry, including a timetable for electronic filing.
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How to fill out Revised First Report of Injury (FROI) form
01
Obtain the Revised First Report of Injury (FROI) form from your state’s workers' compensation agency or employer.
02
Fill in the employer's information, including name, address, and contact details.
03
Provide the employee's information, including full name, address, and date of birth.
04
Describe the injury or illness, including the date, time, and location it occurred.
05
Include details of how the injury happened, including any equipment or circumstances involved.
06
List any witnesses to the incident, including their names and contact information.
07
Indicate whether medical treatment was sought and the name of the treating healthcare provider.
08
Sign and date the form as the person filling it out.
09
Submit the completed form to your workers' compensation insurance carrier and keep a copy for your records.
Who needs Revised First Report of Injury (FROI) form?
01
Employers who have employees injured on the job.
02
Workers' compensation insurance carriers for processing claims.
03
State workers' compensation agencies for regulatory compliance.
04
Employees who need to report workplace injuries for benefits.
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What is Revised First Report of Injury (FROI) form?
The Revised First Report of Injury (FROI) form is a document used to report workplace injuries or illnesses to the appropriate authorities, ensuring that necessary information about the incident is collected for claims processing and compliance with regulatory requirements.
Who is required to file Revised First Report of Injury (FROI) form?
Employers, insurance carriers, or third-party administrators are typically required to file the Revised First Report of Injury (FROI) form when an employee experiences a work-related injury or illness that meets specific criteria set by local or state regulations.
How to fill out Revised First Report of Injury (FROI) form?
To fill out the Revised First Report of Injury (FROI) form, gather all relevant information regarding the incident, including the employee's details, injury specifics, date and time of the incident, and any witnesses. Complete each section of the form accurately and ensure that it is submitted to the appropriate authority within the required time frame.
What is the purpose of Revised First Report of Injury (FROI) form?
The purpose of the Revised First Report of Injury (FROI) form is to formally document work-related injuries or illnesses to initiate the claims process, provide necessary information to medical providers, and fulfill legal reporting requirements, thereby helping manage workplace safety and compliance.
What information must be reported on Revised First Report of Injury (FROI) form?
The information that must be reported on the Revised First Report of Injury (FROI) form includes the employee's name and contact information, employer details, date and time of the injury, description of the injury or illness, location of the incident, treatment received, and any witnesses to the event.
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