Claims Kit
Vermont
Forms
State Compliance Information
Posting Requirements 691
All employers must post and maintain printed notices advising employees of their rights under the Vermont Workers' Compensation Act. The Commissioner prescribes the form and language contained within the notice. Such notice must be typewritten or printed and placed in a conspicuous place in and about each of the employer's places of business. The required notices are below.
Employers Liability and Workers Compensation Poster (Spanish)
Employers Reinstatement Liability Poster (WC-9)
Penalties for Late Reporting 702 704
An employer or insurance carrier who refuses or neglects to submit standard required reports or forms (including those like the Form 13 and Form 13-A) may be assessed an administrative penalty of up to $100 per violation.
Employers or insurance carriers who refuse or neglect to respond to a Commissioner's request for specific claim information within 30 days may be assessed an administrative penalty of up to $1,000.
Physician Selection 640 4.1110
The employer has the right to designate the treating health care provider who will initially treat an injured worker for their injury or illness. If the worker is dissatisfied with the employers choice, they may choose another provider but must first notify the employer or insurer of this change in writing. The worker must also state the reason the employee was dissatisfied with the employer's-elected and provided physician. The name of the new claimant-elected medical provider must be provided when notice is furnished.
The employee need only file a Notice of Intent to Change Health Care Provider (Form 8) once, when they are affecting the change from the employer selected physician to their own election. The employee may subsequently change physicians without further approval.
Reporting of Claim by Employer 701
Employers must maintain record of all injuries--fatal or otherwise--sustained by their employees in the course of their employment. The employer (or the employer's insurance carrier, on their behalf) must report any and all injuries that result in medical care or an absence of work. These reports must be made to the Commissioner within 72 hours. Sundays and legal holidays are excluded from this duration calculation.
Posters & Brochures
Brochure
Documents Provided by CopperPoint
Portal User Help
Pharmacy First Fill - ENG/SPA
Change of Address
Witness Statement - ENG/SPA
Accident Report - ENG/SPA
Gramm-Leach-Bliley Act (GLBA) Privacy Notice
Return To Work
Return To Work Transitional Employment Offer Template - ENG/SPA
Return To Work Policy Guide
Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Need help?
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com