How to file a Workers' Compensation claim
- Download the Employee's Claim for Workers' Compensation benefits 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 . This form is fillable and will automatically calculate the totals, making it easier for the claims adjuster to read and approve for payment.