| A Primer to the 801 Form RisKey |
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| Overview |
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A Guide to the Uses of the Workers’ Compensation Claim 801 Form
You have a dilemma! A worker has just slipped and fallen on the wet marble floor. What do you do? Should you fill out an incident report? Or should the employee file a workers’ compensation claim? Below you will find information which will help in making a decision.
Note: Each agency has an appointed Safety Advisor who can guide supervisors and line managers through this process. Always check your agency practice and procedure.
If there has been an on-the-job event the agency should:
- document the event in an incident report; and,
- conduct an investigation and abate any hazard; and,
- inform the employee that if medical treatment is sought a claim must be filed with the state’s workers’ compensation insurance carrier, SAIF.
The employee is responsible to provide the employer notice of an injury and file a claim with SAIF for potential payment of medical bills and disability. All state group health plans exclude payment for work caused conditions.
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| What constitutes a claim? |
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A claim is an injured employee’s application for workers’ compensation benefits. A claim must:
- be in writing; and,
- come from the worker or someone on the worker’s behalf; and,
- involve a job caused injury or disease; and,
- require medical treatment; or,
- result in the employee’s death.
Under ORS 656.005(6) you will find the definition of a “claim”. A determination of whether a claim is accepted or denied is made by SAIF Corporation, the insurance carrier, for the State of Oregon.
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| Employer notice of the claim |
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What constitutes the employer notice of a claim?
Generally, notification is given to the employer through the 801 form. However, the employer may receive a written notice of a claim through another written format. Always review the following documents for potential workers’ compensation claim exposures:
- Written resignations if an employee states they are resigning due to a job caused health problem.
- FMLA requests that are in writing and indicate medical treatment for a work incident.
- ADA accommodation requests that are in writing that documents medical treatment for an alleged disability caused by a work event.
- Written requests for leave of absence due to work caused injury with medical documentation.
- Medical documents that are submitted to you at your request. (Communication between an employee, and their physician and/or their insurer is not sent to the employer and would not be notice.)
- Accident/incident logs that indicate medical treatment.
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| Who should file a claim? |
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The subject worker or someone on the worker’s behalf must file a claim in writing directly with the employer. Here are some examples of who can file:
- Subject worker
- Wife, Father, Mother or any “dependent” described in ORS 656.005(10).
- Treating physician, through an 827 form, or any other means in writing which clearly lists the work as the cause of the disability as described in ORS 656.005(6).
- An Attorney representing the worker who clearly lists the work as the cause of the disability in writing as described in ORS 656.005(6).
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| Agency Involvement |
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Should an agency file a claim for the employee?
It is the employees’ responsibility to have a claim filed. If a worker who is injured does not file, the Agency Safety Advisor should contact SAIF to determine whether a claim should be filed. Agencies only complete the employer portion of the form. Agencies should also make certain that employees are aware of their rights. Make certain they get access to information. The following are two resources to consider:
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| Where is the claim filed? |
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The requirements of the delivery of the claim by the subject worker or someone on the worker’s behalf can be found in ORS 656.265(3) as follows:
“Notice shall be given to the employer by mail, addressed to the employer at the last-known place of business of the employer, or by personal delivery to the employer or to a foreman or other supervisor of the employer.…”
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| Best Practice |
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- Agency policy should require employees injured on the job to report the injury to their supervisor or appropriate manager:
- as soon as possible, and
- before leaving work, but
- no later than the end of the work shift.
- Agencies should assure employees, injured on the job and who have received medical treatment, have access to file an 801 form. The 801 form, once completed by the employee and employer, should immediately be forwarded to SAIF Corporation. The only section the agency is to complete is the employer’s section.
- When an employee has questions about filing a workers compensation claim there are two resources to consider:
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| Conclusion |
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An incident alone does not constitute a workers’ compensation claim. To have a workers’ compensation claim medical services must be rendered. If an incident occurred with no medical services, an incident analysis form should be completed. An 801 form should not be used as an incident analysis form. Once the form is signed by the worker, that form constitutes notice of a claim for workers’ compensation benefits. The 801 form, once signed by the worker, needs to be filed with SAIF Corporation immediately.
New: October 2004
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