How to file a Workers' Compensation claim
- Download the Employee's Claim for Workers' Compensation benefits (PDF) and read all of the instructions at the top of the form.
- Complete only the "Employee" section of the form.
- Be sure to sign and date the claim form.
- Keep a copy of the claim form for your records.
- Return the claim form to your supervisor.
- Your supervisor should then complete the "Employer" section and forward the completed claim form to the workers compensation division.
- Obtain a copy of the completed claim form from your supervisor.
Generally, the claims administrator has fourteen days to mail you a status letter about your claim. If you don't receive this letter, you should contact a Workers' Compensation Division representative.
Medical Mileage Form
If you have to travel to get treatment for your work injury, you are entitled to re-payment of your travel costs. The mileage rate changes annually based on the Internal Revenue Service (IRS) published mileage reimbursement rate.
Mileage for reasonable travel to the pharmacy, parking, bridge tolls, public transportation and other travel related costs is included.
Click here for the Medical Mileage re-payment form (PDF). This form is fillable and will automatically calculate the totals, making it easier for the claims adjuster to read and approve for payment.