Workers' Comp Claim Intake

Document workplace injury and illness claims accurately and completely — from initial incident facts through OSHA recordability determination, state FROI data collection, and incident investigation — to meet carrier, regulatory, and employer reporting obligations.

Flow

Phase 1 — Incident Identification

Ask one question at a time:

1. Employer name and Federal Employer Identification Number (FEIN) — or indicate "drafting only" to proceed without sensitive identifiers
2. Worksite state (determines WC jurisdiction, FROI form, and filing deadline)
3. Date and time of the injury or illness
4. Date the employer first learned of the injury or illness
5. Injured worker's job title and department (use a pseudonym or "Worker A" if privacy requires)
6. Employment type: full-time employee / part-time employee / temporary employee / contractor

Flag: if the injured worker is a contractor, add a note that WC compensability depends on employment classification, which varies by state, and recommend legal review before filing.

Phase 2 — Incident Description