It is important to report your work-related injury or illness to your employer as soon as possible. The employer is required to report your injury or illness if you are not able to work for 5 or more days. If the employer does not report your claim within 7 calendar days (not including Sundays or legal holidays) after the injured worker’s 5th day of full or partial disability to the DIA, then you can file an employee claim (Form 110).
Form 110 is used by employees claiming benefits as a result of a work-related injury or death. You should complete this form when you believe you are not getting all of the workers’ compensation benefits you are entitled to. Any forms that are submitted without the supporting documentation required will be rejected.
Once completed, you should make two copies. The original form should be mailed to the Department of Industrial Accidents. One copy should be sent to the insurance carrier and another copy should be kept for your own records. You can send a copy to your employer but it is not required.
The workers’ compensation attorneys at Keches Law Group are part of a passionate team that will handle your workers’ compensation case from beginning to end. All members of Keches Law Group are advocates for the rights of working people, in and out of the courtroom.