Understanding the Forms Involved in Your Workers' Compensation Claim Lawyer attorney law firm The process of a workers' compensation claim can be overwhelming, especially  when it comes to understanding and completing documentation that your employer and the insurance company will need from you. 

While this list is not meant to be a complete list of workers' compensation forms you may come across in your claim, it is designed to help you navigate the paperwork you may find being presented to you.

First Report of Injury or Illness Form

The very first form you will come across during the workers' compensation process is the First Report of Injury or Illness form. Be sure to file this form with your employer within 30 days of your on-the-job accident or injury.

On the First Report of Injury form, be sure to include:

  • The date and time of the accident;
  • Where and how severely you were injured (be as detailed, accurate, and complete as you can);
  • The circumstances of the accident and how it happened; 
  • What exactly you were doing when the accident happened;
  • Names of any witnesses; 
  • If the injury was severe enough to require calling 911 emergency services, include that information just in case your attorney decides later to pursue access to that recording.
  • If the accident occurred in an area which is under video surveillance, include that on the report so that the video can be referenced at a later date.

Florida law recognizes that verbally informing your employer is sufficient to begin a worker's compensation claim, however having this information and all the details in writing can prevent confusion, miscommunication, or the loss of the details of "what really happened" which can occur naturally with time.

Here is a standardized First Report of Injury form for all industries, provided by the Florida Department of Financial Services. Your employer may have specific forms which cover additional information pertinent to your industry.

Take the time to speak with your employer about all these details and request copies of all documentation for your own records. What happens if you don't report an injury within 30 days? Click here.

Wage Statement Form

The Wage Statement Form from the Florida Department of Financial Services is a form which the employer must submit to their claims-handler within 14 days of their knowledge of any accident which results in disability. It is an invaluable part of the process for injured employees because it will be used to calculate normal wages in order to determine reasonable payment for those lost wages due to the injury.

The weekly compensation for the employee is determined by calculating the average of their weekly earnings for the 13 weeks preceding the accident (not including the week in which the injury/accident occurred) for employees who were working full-time hours at least 10 of those 13 weeks. This calculation also provides for gratuity, commissions, and fringe benefits which the injured employee has lost. If the employer stops paying fringe benefits during the workers' comp claim process, they must file a corrected Wage Statement Form within 7 days of stopping those benefits.

Employee Earnings Report

The Florida Chief Financial Officer website also provides a standardized form called the Employee Earnings Report for employees to report to their employers, the department of worker's compensation, and the insurance company on the amount of money which they have received during the course of a worker's compensation claim. This form includes sections to report on self-employed earnings, insurance settlements, or worker's comp payments. The employee has 21 days to complete this form once it is requested of them. 

Notice of Denial Form

If an insurance company has decided to deny a worker's compensation claim they are required to submit a Notice of Denial within 21 days of a worker's request for benefits. There are many reasons an insurance company may decide to deny a claim, including Drug Free Workplace violations, evidence gathered under surveillance, or any situation where the insurance company can support a belief that the claim is fraudulent.

The denial of a worker's comp claim may not be the end of the process and the injured worker has rights to appeal the denial.

Petition for Benefits Form

In the event that a worker's compensation claim is denied or disputed, the Office of the Judges of Compensation Claims is responsible for handling and resolving these disputes. The form an injured person would file with them to begin the process of mediation is the petition for benefits form. This form provides space to report much of the same information as the First Report of Injury or Illness, and allows a person seeking worker's compensation for their injury to fully describe the history of their situation.

Filing this form serves as a notice to the OJCC of the injured person's request to require the employer to pay the compensation for lost wages they feel they are owed.

Maintaining Your Medical Treatment Forms

The first and most important factor in any workers' compensation claim is your health. If you are injured in the course of your work duties, do not hesitate to seek medical attention immediately. Be sure to be honest and complete when speaking with your doctor and when filling out forms at medical offices, as these documents can become part of the workers compensation claims process and are official documentation relevant to your case. 

You should maintain visits with the same doctor or office consistently in order to keep uniformity in your evaluations and treatment. Be sure not to jump around to various doctor's offices, consistency is key both in the recovery of your health and the processing of any workers' comp claim.

Your employer will recommend a specific office or facility based on the worker's comp insurance they provide. Contact or visit this office primarily if possible, and request a documented referral to your specific doctor if you are more comfortable with maintaining treatment in the future from someone you have received it from in the past. Disagreement with any doctor can be understandable, but remember that your treatment toward the medical professionals you come in contact with could have an effect on your claim.

Personal expenses, such as mileage and the cost of gas incurred by driving to medical treatments can be included as part of your worker's compensation claim and can be reimbursed to you. While it is not necessary to keep track of these in a specific format, it can be helpful to use a standard form to show the employer and the insurance company what these regular costs are. Coye Law Firm has designed a simple Mileage Reimbursement Form to easily track these expenses.

Further Reading: 

If you have questions about your workers’ compensation claim you can download a FREE copy of Wade Coye’s book, Sharing the Secrets, Learning the Lies: A Guide to Florida Workers’ Compensation. You can also contact our expert team by calling (407) 648-4940 today or by filling out a contact form.


Wade B. Coye
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Attorney/Author Wade Coye - serving consumers legal needs for over 27 years