Tag Archives: work comp forms

First Report of Injury

Basic Worker’s Compensation Forms

If you have experienced a workplace injury, you may have already filled out one or two documents regarding your injury. There’s a lot more where that came from. You may have even receive the same document twice at different times or for different purposes.

Here, my goal is to help simplify this process by giving you a brief description of these common forms or documents.

Affidavit

An affidavit is a written statement confirmed by oath or affirmation. It can be used as evidence in court. The uses for affidavits are broad, such as an Affidavit of Service or an Affidavit of Significant Financial Hardship.

Answer to Claim Petition

This document is filed by your employer or its insurer. In the answer, the employer or insurer must respond to your claim by stating whether they admit or deny the information alleged in the claim petition.

Claim Petition

If an employer denies your workers’ compensation claim and refuses to pay benefits, a claim petition is a form used to challenge the denial through the Office of Administrative Hearings.

Discovery Demand/Discovery Requests & Discovery Response

A discovery demand (also referred to as a discovery request) is a document given to the other party to request information. A discovery demand usually includes requests for specific information or documents. If you are given a discovery demand, you must file a discovery response, which is the document answering the opposing party’s questions.

First Report of Injury

A First Report of Injury (“FROI”) is the document your employer should complete immediately after a workplace injury occurs. This is a reporting document that goes to both your employer’s insurer and the Minnesota Department of Labor. The document provides basic information about your injury in order to start the claim process.

Notice of Benefit Reinstatement

A Notice of Benefit Reinstatement (“NOBR”) is a document used to report that your benefits are resuming after you received a Notice of Intent to Discontinue benefits. It can also be used to indicate a change in your wage-loss benefits.

Notice of Insurer’s Primary Liability Determination

An employer/insurer sends an employee a Notice of Insurer’s Primary Liability Determination (“NOPLD”) to indicate whether or not it will pay your workers’ compensation benefits. Usually, the insurer will provide a very short description of why your claim is denied if the employer/insurer believes it is not responsible for paying any benefits.

Notice of Intention to Discontinue Workers’ Compensation Benefits

A Notice of Intention to Discontinue (“NOID”) benefits is sent to the employee to inform him or her of a reduction or discontinuance of temporary total disability, temporary partial disability, or permanent total disability benefits. If you have received a Notice of Intention to Discontinue, you can fight the determination. I highly suggest speaking with an attorney about your case if you believe your benefits are not properly being terminated.

Retainer

If you hire a workers’ compensation lawyer, you will be asked to sign a retainer or an attorney-client agreement. Most frequently, this document will explain the scope of the attorney’s representation (in other words, why you hired the attorney), responsibilities of the parties, agreement for attorneys’ fees, and the right of either the attorney or the employee to withdraw from the relationship.

Work Comp Attorney Consultation

If you have received one of these forms, especially if it indicates your employer will not pay your claim, you need to consider obtaining a workers’ compensation attorney to fight for your rights. A workman’s comp attorney can maximize the chances of obtaining benefits as well as maximize the amount of any benefits owed to you.

At Heimerl & Lammers, our experienced team of Minneapolis workman’s compensation lawyers are available to discuss your case in a free consultation. To schedule a consultation, call our office at 612-294-2200.