Claims Kit

Physician Selection 65-05-28.2  65-05-28

In an emergency:

Seek immediate medical care at the nearest emergency room
Notify the health care provider that the injury is a workers' compensation injury
As soon as possible after the injury occurred, notify the employer

In all other instances:

Inform the employer of the injury before seeking medical care

All injuries, no matter how small, should be reported to the employer

If the employer has a Designated Medical Provider (DMP)

Employees are required to see the company’s DMP for medical care
Unless the employee has previously informed the employer, in writing, of a different medical provider selection before any injury occurred they must see the DMP
Employee may request to change providers with WSI after 30 days of treatment by the DMP contact WSI to request a Change of Doctor form (C6)

If the employer does not have a DMP

Employee may seek treatment from the medical provider of their choice
For a change of drs written authorization from WSI is needed. Request a Change of Doctor form (C6)

WSI will monitor the employees medical treatment to make sure they are receiving quality and appropriate medical care for their injury. When warranted, WSI may require the employee  to change doctors or transfer care.

Change of health care provider   92-01-02-38

All changes from one health care provider to another must be approved by the organization. Normally, changes will be allowed only after the injured employee has been under the care of the primary health care provider for sufficient time for the health care provider to complete necessary diagnostic studies, establish an appropriate treatment regimen, and evaluate the efficacy of the therapeutic program.

Posting Requirements

WSI provides this poster to all employers so they have a visual for their employees. It covers the basic details of workers compensation that would be helpful for the worker if they suffer an injury and what type of benefits they can receive. The Designated Medical Provide DMP selection must be visible to workers at all locations, including at mobile worksites. Failure to give notice, post notice, or to inform employees of the DMP voids the selection.

Important Notice to Employees

Reporting of Claim by Employer 65-05-01.4.

An employer is required to file a First Report of Injury with the Workforce Safety & Insurance (WSI) within 7 days of receiving notice of an injury from an employee

Early Claim Reporting Incentive

Medical Assessment Information

An employer is responsible for the first $250 or $350 of medical expenses for each worker’s compensation claim filed with North Dakota Workforce Safety & Insurance (WSI). Employers are billed monthly for assessable claims costs paid during the previous month. WSI offers an early reporting incentive and may waive the assessment charge.

Assessment Fee

WSI Waives Assessment Fee

If a claim is filed with WSI by midnight (central time) of the next WSI business day following the injury date, the assessment fee is waived by WSI.
Incident Report: If a worker reports an incident, but does not seek immediate medical attention, the employer should file an Incident Report online on WSI's website. In order to qualify for the $250 waiver, the incident should be filed by midnight (central time) of the next WSI business day following the injury date. If that worker later seeks medical attention and a claim is received by WSI within 14 calendar days of the incident, the $250 assessment charge will be waived. Without the filing of the Incident Report, the $250/$350 medical assessment will still be charged if a claim is eventually filed.

Employer pays $250

If an injury occurs and the claim is received by WSI or filed by a medical facility within 2-14 calendar days after the injury date, the employer is responsible for the first $250 of medical expenses.

Employer pays $350

If an injury occurs and the claim is received by WSI or filed by a medical facility more than 14 calendar days after the employer notification date, the employer will be charged the first $350 of medical expenses.

Penalties for Late Reporting  65-05-01.4

Failure of the employer to file a first report of notice of injury is an admission by the employer that the alleged injury may be compensable.