First Report of Injury:

1. First Report of Injury: Changed a bit in January 2002, people still think of this as “new.” Changes were driven by changes in regulations.

2. First Report of Injury • A report must be made for any workplace injury or illness incident that occurs. • The supervisor must complete both sides of the form within 24 hours of the incident. • A copy of the completed form must be sent to REM within 48 hours of the incident.

3. Liberty Mutual • Lib Mut is the University’s Claims Administrator for Worker Compensation and Occupational Medical claims. • The supervisor is to call Liberty Mutual ONLY if the employee: 1) Has lost work time, OR. 2) Has obtained medical treatment.

4. First Report of Injury: Form Front Left • See the small box on the left side of the page. • Title, phone, date of Supervisor. • It is NOT OK for the Supervisor to tell the employee to “fill it out and give it to me to sign.”

5. First Report of Injury: Front Center • Employee Name, Address, Date of Birth, Date Hired, Gender • Physician Name, Medical Facility name, ER?, overnight/inpatient? (writing N/A is acceptable if true)

6. First Report of Injury: Front Right • Info about case • What was employee doing before? • What happened? • What is injury or illness? • What object/substance directly harmed the employee? • Time/date of death?

7. First Report of Injury: Back • Purdue pays Liberty Mutual about 1 M$ per year simply to administer (not pay) the worker comp and occupational medical insurance claims. • The form back is information that is required by Liberty Mutual, REM, or by Purdue Compensation and Benefits

8. First Report of Injury: Back • Info must be accurate • If claim not paid, bill will be sent to employee (if there is a bill). • If employee doesn’t pay, the bill will be turned over to a collection agency.

9. First Report of Injury: Back • Note particularly: • Root cause of accident • Corrective action taken • Be careful to document this corrective action.

10. First Report of Injury: ….form finished • MAKE A COPY -- never ever send your only copy of something important to someone else. • send the copy to REM and keep the original. • Supervisor must have the original, completed form in hand while making the phone call.

11. The phone call • Purdue pays Liberty Mutual approx 1 m$ per year …. • Every phone call that is made erroneously costs a little more. • Over the year, thousands of dollars worth of phone calls are made.

12. The phone call • Supervisor must make the phone call…. • IFF the employee received medical treatment or lost time BEYOND the date of the injury • Supervisor must have the completed form in hand when making the call.