Get the free SI-4 - Workers' Compensation Board - wcb ny

How to fill out si-4 - workers39 compensation

How to fill out si-4 - workers' compensation:

1. Firstly, gather all necessary information such as the employee's name, job title, and contact details. You will also need information about the employer and the incident that resulted in the injury.
2. Fill in the employee's personal details accurately, including their address, phone number, and social security number.
3. Provide detailed information about the employer, including their name, address, and contact information. If there is a workers' compensation insurance policy, include the name of the insurance carrier.
4. Describe the injury or illness incurred by the employee. Include the date, time, and location of the incident. Be specific and detailed in explaining what happened and the circumstances surrounding the injury.
5. Indicate the body parts affected by the injury or illness. Specify if it is a specific injury like a fracture or a general illness.
6. Provide information about the medical treatment received by the employee. Include the healthcare provider's details, the dates of treatment, and any hospitalization if applicable.
7. Include any witnesses to the incident. Provide their names, contact details, and a brief description of their involvement or what they witnessed.
8. Once all the required information is filled out accurately, review the form for any errors or missing information. Ensure that all details are completed and legible.
9. Sign and date the form as the employer or representative responsible for completing the workers' compensation report. Keep a copy of the form for your records.

Who needs si-4 - workers' compensation?

1. Employers: Employers, especially those who have employees that could potentially be injured or become ill while working, need the si-4 form to report workers' compensation incidents. It is a legal requirement to inform the workers' compensation authorities about any workplace accidents resulting in an injury or illness.
2. Employees: Workers who sustain on-the-job injuries or develop work-related health conditions may need the si-4 form to properly document and report their incident. This form helps employees seek appropriate medical treatment and file their workers' compensation claim.
3. Workers' Compensation Authorities: The si-4 form is required by workers' compensation authorities to track workplace incidents and ensure that employees receive the necessary benefits and support for their injuries or illnesses. It allows them to maintain accurate records and investigate potential fraudulent claims.

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