North Dakota Workforce Safety & Insurance Labor Law Poster

[laborlaw]

Filing a claim (3 methods):
By hand: Complete the Claim Form Packet and submit to WSI

Important Notice to Employees
The information contained in this poster is effective August 1, 2003. This poster is updated, reprinted, and distributed toemployers every two years. For a detailed explanation of the information contained in this poster, please contact WSI at the numbers listed above
When you are injured on the job:

1 Report your injury to your employer immediately - don’t delay. By law, you must give written or oral notice to your employer within seven days of an or after the general nature of your injury becomes apparent. If you fail to notify your employer, Workforce Safety & Insurance (WSI) may consider that failure when deciding whether your claim will be accepted.
2 Seek first aid or medical attention, if necessary. Consult a doctor of your choice unless your employer is participating in WSI’s Risk Management Program - in which case you must seek treatment from your employer’s designated medical provider (DMP) unless you have taken the required steps to select another provider. Contact your employer or WSI for more detailed infor-mation about this requirement. Emergency medical treatment is exempt from the DMP requirement. Inform the doctor that your injury is a workers’ compensation injury. Also, inform the doctor of your work duties and ask if you can return to work within any work restrictions the doctor may impose. Follow restrictions, both on and off the job.
3 WSI encourages you to immediately (within 24 hours of occurrence) file a claim with WSI after a work-related injury occurs.
Whichever claim filing method is used, complete the claim form with your employer, if possible. Answer all questions fully and honestly on the claim form. Be sure to have your employer complete the Employer’s Report of Injury (C2) form. If you have received benefits for an injury and are now off work again for that same injury, you must reapply for benefits in writing. Contact WSI and request a Worker’s Notice of Reapplication (C4) form.
4 WSI will inform you of your claim number, in writing, upon registering your claim. Be sure to always inform the pharmacy and medical provider of your claim number.
5 Keep in touch with your employer and provide them with periodic updates on your condition.
6 Notify WSI immediately when you perform any type of work, whether you receive pay for it or not, if you change your address or telephone number, or if you apply for either Social Security disability or retirement benefits or are found to be eligible for these benefits.

Benefits for injured workers:

Medical Benefits
Upon claim acceptance, WSI pays for all work-related prescriptions and medical care determined to be reasonable and necessary in accordance with fee schedule limitations. Some medical procedures require prior authorization.
Disability Benefits (Wage Replacement)
An injured worker may be entitled to disability benefits if their doctor orders them not to work for five or more calendar days in a row because of their work-related injury or illness. Workers receive 2/3 of their gross weekly wage at the time of their disability. This rate may not exceed the maximum benefit, which is equal to 110% of the state’s average weekly wage. The disability benefit, combined with the dependency award, may not exceed the worker's net wage.
Permanent Partial Impairment (PPI)
This benefit is for workers who suffer permanent physical loss of a body part or function because of a compensable work-related injury. PPI benefits are given only if the full-body impairment meets or ex-ceeds the statutory minimum impairment. Once a worker reaches maximum medical improvement, a doctor will then determine the level of permanent impairment. This is a one-time, lump-sum pay-ment that is tax free.
Return-to-Work Services
These services may be assigned to an injured worker to assist in co-ordinating medical treatment or return-to-work planning. Different types of return-to-work services include return-to-work case management, medical case management, and vocational rehabilitation services.
Reimbursement for Personal Expenses
WSI will reimburse an injured worker (upon their request) for medicine, mileage, meals, and other out-of-pocket costs that are necessary for their medical care, within the limits of the law. Original, itemized, and dated receipts are required. Injured workers can download the ap-propriate form (C40a) from our web site or request it from our office.
Death Benefits
WSI pays benefits to the survivors of workers killed in work-related s. Survivors must file a claim within two years of the worker’s date of . Survivors receive 2/3 of the deceased worker’s gross weekly wage, up to a maximum of 110% of the state’s average weekly wage. Total benefits may not exceed $250,000. Funeral expenses are payable up to $6,500.
Office of Independent Review (OIR)
The Office of Independent Review (OIR) provides no-cost assistance to injured workers attempting to resolve disputed issues on a claim. Advocates help avoid costly and lengthy litigation. The program opens the lines of communication between parities and offers an inde-pendent review of the claim. Advocates act on behalf of the injured worker and communicate with WSI staff. OIR is part of WSI, but is independent of WSI’s Claims Department.
llc rev. 01/04