First Report Of Occupational Injury Or Disease Form - Delaware Department Of Labor (Page 2 of 2) in pdf

First Report Of Occupational Injury Or Disease Form - Delaware Department Of Labor Page 2

WORKERS’ COMPENSATION

IMPORTANT THINGS TO DO IN CASE OF INJURY

THE EMPLOYER SHOULD:

1. Provide all necessary medical, surgical and hospital

treatment from the date of accident.

2. Every employer shall keep a record of all injuries received

by employees and make a report within 10 days thereof in

writing to the Office of Workers’ Compensation

3. Ascertain the average weekly wages of the employee and

provide compensation in accordance with the provisions of

the law, for disability beyond the third day after the

accident. All agreements as to compensation must be

submitted to the Office of Workers’ Compensation for

approval.

THE EMPLOYEE SHOULD:

1. Immediately notify the employer in writing of accidental injury

or occupational disease and request medical services. Failure to

give notice or to accept medical services may deprive the

employee of the right to compensation.

2. Give promptly to the employer, directly or through a supervisor,

notice of any claim for compensation for the period of disability

beyond the third day after the accident. In case of fatal injuries,

notice must be given by one or more dependents of the deceased

or by a person on their behalf.

3. In case of failure to reach an agreement with the employer in

regard to compensation under the law, file application with the

Industrial Accident Board for a hearing on the matters at issue

within two years of the date of accidental injury or one year of

knowledge of the diagnosis of an occupational disease or an

ionizing radiation injury. All forms can be obtained from the

Office of Workers’ Compensation.

First Report Of Occupational Injury Or Disease Form - Delaware Department Of Labor Page 2