File A Work Comp Claim

What do I have to do?

Report all on-the-job injuries or occupational diseases to your supervisor, insurer or employer as soon as possible. You must give notice within 30 days after the occurrence of the accident (one year from the date you knew or should have known your condition from an occupational disease.) The notice must include time and place where the accident occurred and the nature of the injury. We recommend you report minor injuries to your employer whether or not you receive medical treatment.

You must submit a written and signed First Report of Injury (FROI) within 12 months from the date of the accident or occupational disease. You can submit this form to your employer, the workers’ compensation insurer or the Department of Labor & Industry.

Upon receipt of your signed FROI, the insurer has 30 days to accept or deny your claim. If your employer does not have a FROI form, you may use one of the forms below.

First Report of Injury (FROI)

FROI Instructions

  • Used by an injured worker to report an injury or occupational disease to his/her employer
  • Used by an employer to report an injured worker’s injury or occupational disease to the employer’s insurer/adjuster
  • Used by an insurer/adjuster to report claim data to the Department

Legal size form - recommended for those who wish to complete it long hand.
Letter size form - this form in WORD format for those who wish to complete it on their computer.