Claims Kit

Physician Selection 65-05-28.2  65-05-28.1

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:

During the first thirty days after a work injury, an employee of an employer that has selected a preferred provider may seek medical treatment only from the preferred provider for the injury. Treatment by a provider other than the preferred provider is not compensable and the organization may not pay for treatment unless a referral was made by the preferred provider.

An employee of an employer that has selected a preferred provider may elect to be treated by a different provider provided the employee makes the election and notifies the employer in writing before the occurrence of an injury.

After thirty days have passed following the injury, the employee may make a written request to the organization to change providers. The employee will make the request to  the employer and the organization at least thirty days before treatment by the provider. The employee must state the reasons for the request and the employee's choice of provider.

If the employer objects to the provider selected by the employee, the employer may file an objection to the change of provider. The employee may serve, within five days of the  objection, a written response to the employer and the organization in support of the request for change of provider. Within fifteen days after receipt of the response or of the expiration of the time for filing the response, the organization must rule on the request. Failure of the organization to rule constitutes approval of the request. Treatment by the employee's chosen provider is not compensable until the organization approves the request. The preferred provider remains the treating provider until the organization approves the employee's request to change providers.

An employer that selects a preferred provider must give notice and post notice as required

Failure to give written notice, to properly post notice, or to reasonably inform employees of the terms of the preferred provider program as required invalidates the selection for the employee's claim.

Prior to treating an injured employee, a medical provider should become familiar with WSI's treatment and documentation policies. These policies serve to guide care and outline documentation requirements for certain medical and surgical services.

WSI considers the following practitioner types eligible to be a primary treating provider: MD, DO, APRN, PA, DC, DPM, OD, DDS, DMD, PT. An injured employee may only have one primary treating provider, who manages treatment, assesses functional capabilities, and determines when the injured employee

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.

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 Workers  

Important Notice to Workers (Spanish)

April 17, 2020

WSI Temporarily Extends Filing Timeframe for a Medical Bill Appeal

WSI is temporarily extending thefiling timeframe from 30 days to 60 days for appealing a previously reduced or denied medical bill. Due to the COVID-19 pandemic, many providers have transitioned to working from home, which WSI recognizes may cause a delay in submitting aMedical Bill Appeal (M6)form.

Executive Order to Assist Employers

Governor Doug Burgum todayissuedExecutive Order 2020-15which provides employers a reprieve from reporting requirements, permitting them to attend to the urgent task of preserving business operations and retaining critical cash flow during the COVID-19 pandemic. The order is a collaboration between WSI andJob Service North Dakota.

Report injuries, access policy documents, or make payments online atmyWSI.