Managing Claims Overview

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Claims Coordinator Responsibilities

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Choosing a Medical Provider

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When an Injury Occurs
   Finding Out About an Injury
   Your Five-Step Response
   First Report Checklist
   What the Employee Receives
   Handling Medical Records
   Situations to Watch For

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Report an Injury

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Return to Work

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Fraud

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Lowering Your Costs

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First Report of Injury Checklist

After an injury occurs and you’re ready to submit the First Report of Injury, make your job easier by pulling together the necessary information. Most of it may be in the employee's personnel file.

Items needed:

• Employee's Social Security number
• Employee's full name
• Employee's date of birth
• Employee's current address
• Accurate wage information to reimburse the employee for lost wages
• Date the employer was notified or became aware of the injury
• Date of first day of lost time, and date employer was notified of lost time (Minnesota only)
• Date of last day worked, even if a partial day (Wisconsin only)
• Date employee returned to work
• Did you pay the employee for lost time on the day of injury?
• Treating physician's name, address and phone number along with the hospital or clinic name, if the employee sought treatment

Details about the accident:

• How did the injury occur?
• What was the employee doing before the incident?
• What was the injury or illness? Include specific parts of the body.
• What tools, equipment, machines, objects or substances were involved?

If you need assistance completing a First Report, call your SFM claims representative at (952) 838-4200 or (800) 937-1181.

Related SFM resources Avoid these reporting mistakes CompTalk (Minnesota) State laws and penalties CompTalk (Minnesota) Accident analysis CompTalk SFM Employer Kit These resources, plus more on other topics, are available in SFM’s Resource Catalog.