Montana State University-Northern
Workers' Compensation
Claim Reporting Procedures

Each employee must report any work related accident or injury immediately to his/her supervisor, unless precluded by emergency medical treatment. The supervisor, with the employee’s assistance, or without, if the employee is incapacitated, must complete the First Report of Injury and Occupational Disease within 24 hours. If the employee is not available for signature email or fax the report without the signature and obtain a signature as soon as possible. If there is any reason to question the claim, the supervisor should check the appropriate box on the claim form and provide relevant information.

If an employee is hospitalized or is expected to miss work because of the injury/illness the supervisor must notify the Director of Human Resources (265-4147) immediately.

The First Report is available by clicking on the link above. Save the completed form as a word document file on your computer then attach the file to an e-mail to: kjaynes@msun.edu. Send a signed copy of this report to the HR Director by fax or campus mail.

An injured employee requiring medical attention must notify his/her supervisor of treatment as soon as possible. Notification must include the name and phone number of the medical provider. Supervisors must then notify the HR Director. The supervisor will maintain close contact and coordination with the HR Director for return to work activities and/or any temporary job modifications that may be needed.

If the injury or illness keeps the employee out of work:

  1. The supervisor is responsible for completing the Supervisor’s Accident Investigation Report. This report must be completed if injuries result in time away from work beyond the day of injury. This form is available by clicking on the link above. The supervisor shall conduct an inquiry into the circumstances of every incident/accident. The inquiry should address all factors bearing on the incident, including input from any applicable witnesses. Every attempt should be made to identify the root cause(s) of the incident so that corrective actions can be taken to prevent recurrence. Management personnel are available to assist the supervisor in this investigation.
     
  2. The employee needs to stay in touch with the supervisor and with the workers’ compensation claims representative.
     
  3. The supervisors will keep the HR Director informed of the work status of the injured person on a weekly basis. The Occupational Accident or Illness Lost Time Report is available by clicking on this link.

If you have questions or problems regarding treatment or benefits call Kathy Jaynes at 265-4147.

Montana Code Annotated: 39-71-736 – Compensation – from what date paid.
1. a. Compensation may not be paid for the first 32 hours or 4 days’ loss of wages, whichever is less that the claimant is totally disabled and unable to work due to an injury. A claimant is eligible for some compensation starting with the 5th day.

Remember, when you are out of work, a lot of people care about your progress. MSUN has a big investment in you and your training, cares about your well-being, and wants you to recover and return to your job as soon as possible.

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