How to file a workers Compensation Claim

1. The employee notifies his or her supervisor, typically by e-mail, telephone, or in person.

2. The supervisor informs the appropriate agency human resources representative or leave administrator.

3. The employee and the supervisor complete required forms and reports. The “Workplace Injury and Illness: A Guide for the King County Employees, Supervisors and Doctors” packet which includes all the following necessary forms to initiate a workers’ compensation claim:

a) “Work Related Illness or Injury Supervisor Report Form” (completed by the employee and the supervisor) which may be accessed at http://des-icomp:8080/kc_firstrpt.shtml

b) “Self-Insurer Accident Report (SIF-2)” (completed by the employee)

c) “Physicians Initial Report” (completed by the employee and his or her health care provider)

d) “Activity Prescription Form” (completed by the employee’s health care provider)

http://www.kingcounty.gov/employees/HumanResources/SafetyClaims/WorkersComp/Forms.aspx

4. The employee visits his or her health care provider. To be eligible for workers' compensation, you must see a doctor. When you do, let the doctor know the County is self-insured and this is an on-the job injury. You and your doctor need to complete a Physicians Initial Report for self-insured employers, which must be returned to the workers' compensation section of King County's Safety & Claims Management Division.

5. The employee and/or the employee’s supervisor report the employee’s injury or occupational disease to Safety and Claims and provides Safety and Claims the required forms [Note: In an emergency, the supervisor may notify Safety and Claims]

Work Related Illness or Injury Report Form:  http://146.129.33.132:8080/4dcgi/first_report/kc_firstrpt.a4d

If the employee can return to work with restrictions:

The employee must notify the supervisor, human resources representative, or agency leave administrator of any work limitations by providing written notification from the health care provider that identifies the restrictions. The employee and supervisor discuss whether the employee may perform his or her job with or without restrictions. Safety and Claims is informed of any restrictions.

There are occasions where Safety and Claims receives the restriction information directly from the health care provider or employee. In those circumstances, Safety and Claims will notify the employee’s agency. A coordinated effort will be made between Safety and Claims, the employee, the supervisor, and the employee’s health care provider regarding restricted duties.

If the employee can return to work without restrictions:

The employee’s health care provider may indicate on the APF or on a form appropriate to the employee’s division that the employee can return to work without restrictions. In that circumstance, it is the employee’s responsibility to provide the form to his or her supervisor. The supervisor is responsible for sending the form and reporting on the employee’s work status to Safety and Claims. As stated above, if Safety and Claims receives the information directly from the health care provider, Safety and Claims will notify the employee’s agency.