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HOW TO REPORT AN INJURY
California
Within 24 hours of knowledge of an injury, you will need to
provide the injured worker with the DWC-1 Form, Employee’s Claim for Workers’
Compensation Benefits. Have the injured worker complete the top
portion of the form and return it to the appropriate Supervisor or
Manager. The employer will then complete the bottom portion of the
document and give the injured worker a copy.
Next, you will need to complete the 5020 Form, Employer's Report of Occupational
Illness or Injury. This form and the DWC-1 are provided in the
Employer's Claim Kit package sent at policy inception and when your
policy renews. Both forms can also be downloaded by clicking on the
links on this page.
Once both of these documents are filled out, they need to be
faxed to American All-Risk Loss Administrators at (800) 500-3486 or
(559) 277-4961. Documents can be faxed at any time, 7 days a week.
Or, claims can be reported to one of our operators, Monday through
Friday, between the hours of 8:00 a.m. and 5:00 p.m.
After you fax these documents to AARLA, they are received by the
"Fast Track" Department which handles the intake of new claims. You
will receive a follow-up telephone call from the Fast Track
Department to obtain and verify information that is needed in the
initial investigation, and to advise you of AARLA's receipt of your
claim. You may also wish to contact AARLA to ensure follow-up of the
claim, and we can be reached at (800) 500-3744, or (559)
277-4960.
Please be sure to keep a copy of both the DWC-1 and 5020
documents for your records. California law requires that
employers report within five days of knowledge a claim for an
occupational injury or illness that results in lost time from work
beyond the date of the incident OR requires medical treatment beyond
first aid. Failure to report claims timely can jeopardize AARLA's
ability to promptly investigate an injury, and can lead to
unnecessary and excessive medical and disability costs, state
penalties and fines, and a higher likelihood of litigation. Your
cooperation in prompt reporting is a key factor in managing your
workers' compensation insurance expenses.
New York
Within 10 days of an injury, you will need to complete the C-2 Employers Report of Work
Related Injury/Illness form. This form is provided in the
Employer's Claim Kit package sent at policy inception and when your
policy renews. The form can also be downloaded by clicking on the
links on this page.
Once the document is filled out, they need to
be faxed to American All-Risk Loss Administrators at (888)-773-2239
or (631) 769-0373. Documents can be faxed at any time, 7 days a
week. Or, claims can be reported to one of our operators, Monday
through Friday, between the hours of 8:00 a.m. and 5:00 p.m.
After you fax these documents to AARLA, they are received by the
"Fast Track" Department which handles the intake of new claims. You
will receive a follow-up telephone call from the Fast Track
Department to obtain and verify information that is needed in the
initial investigation, and to advise you of AARLA's receipt of your
claim. You may also wish to contact AARLA to ensure follow-up of the
claim, and we can be reached at (888)-773-2238 , or (631)-319-6210.
Please be sure to keep a copy of the C-2 for your records.
New York law requires that employers report within 10
days of knowledge a claim for an occupational injury or illness that
results in lost time from work beyond the date of the incident OR
requires medical treatment beyond first aid. Failure to report
claims timely can jeopardize AARLA's ability to promptly investigate
an injury, and can lead to unnecessary and excessive medical and
disability costs, state penalties and fines, and a higher likelihood
of litigation. Your cooperation in prompt reporting is a key factor
in managing your workers' compensation insurance
expenses.
New York Forms :
C-2 Employers Report of Work
Related Injury/Illness form
C-11 Employers Report of Injured Employees
Change
C-240 Employers
Statement of Wage Earnings
DISCLAIMER
Any person who makes or causes to be made any false or
fraudulent material statement or material representation for the
purpose of obtaining or denying workers’ compensation benefits or
payments is guilty of a felony.
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