How to Report an Employee s Injury online

Transcription

1 Accessing the Electronic Employee First Report of Injury Form 1. Visit the Workers Compensation website: 2. Click on the Employee First Report of Injury Form link located in the Forms/Documents and Other Links section of the website. 3. Log in using your Yale Net ID and Password, then click Login. 4. A Security Information window may appear. If so, click Yes. 5. Ensure that you have the minimum information listed in step 1, write down the PMA User name and Password listed in step 2, then click on the PMA Online link in step Log in using the PMA User name and Password, then click OK. 1

2 Filling out the Electronic Employee First Report of Injury Form 1. Workers Compensation should appear in the drop-down menu. If not, click on the drop-down arrow and select Workers Compensation. Then click GO. 2. Click on the drop-down arrow and select the State where the employee s accident occurred, then click GO. If the accident occurred outside the United States, select Connecticut as the Accident State. 3. Enter the injured employee s last name into the Employee Last Name Search field, then click Search. 4. Select the injured employee from the list that appears by clicking once on their name. If the injured employee is not on the list, click on the Employee Not On List button and fill out all required fields (in blue). 2

3 How to Report an Employee s Injury online Completing fields: Certain fields are automatically populated and do not need to be filled out. If you feel any of the information automatically populated is incorrect, please contact the Workers Compensation Department at Required fields are colored blue and must be filled out in order to complete the claim. All other fields are optional and are not required to be filled out to complete the claim. Please provide as much information as you can in the optional fields. 5. Fill out all required Employee Information fields, then click Next: Required Employee Information Location* Click on the drop-down arrow and scroll down to select the location where the injury occurred. * If the accident occurred outside the U.S., select ZZOTHER Other : Location Not Found as the Location. Provide further information about the accident location on the Occurrence Information screen in the Accident field (see below) or in the Comments field on the Claim Submission screen. 3

4 6. Fill out all required Occurrence Information fields, and as many other fields as you can, then click Next. Required Occurrence Information Date of Injury/Illness Accident Cause Injury Nature Body Part Accident Date Employer Notified Is the Injured Worker Losing Time? Is the Injured Worker on Modified Duty? Enter the date the injury occurred (mm/dd/yyyy format). Click on the arrow and select the cause of the accident. Click on the arrow and select the nature of the injury. Click on the arrow and select where on the body the employee was injured. Click in the field and type in a description of how the accident occurred. If the accident occurred outside of the U.S., include more information here about the actual location of the accident. Enter the date Yale was notified of the injury (mm/dd/yyyy format). Click on the arrow and select the appropriate response. Click on the arrow and select the appropriate response. 4

5 7. Fill out all required Contact Information fields, and as many other fields as you can, then click Next. IMPORTANT: If you are not the injured employee s supervisor, add the supervisor s name and phone number in the Employer Contact fields (Employer Contact First Name, Last Name, Phone). Required Contact Information Preparer s First Name Last Name Phone Type in your first name. Type in your last name. Type in your Yale telephone number. 8. The injured employee s Yale UPID number and Org Number are listed. IMPORTANT: If the employee s injury was a puncture by an object (i.e. needle) that included human material, select the appropriate answer to the Addl. Injury Info? question. Click Next. 9. Use the Comments field to add any additional information you were unable to fit in the Accident field on the Occurrence Information screen, including details about foreign accident locations. Check the Send Copy box. Type your address in the Additional Address(es) box, and add any other addresses you wish to be copied on the report. Click Submit Claim. 10. Your screen will display a claim number. Give this number to the injured employee. 5