Sample Letter Reporting Your Industrial Accident and Work-Related Injuries to Your Employer

 

Learn What to Include in Your Work-Related Accident Report Form to Protect Your Right to Workers Compensation Benefits

 

The path to receiving workers compensation benefits starts almost as soon as you are injured on the job or diagnosed with an occupational disease.

 

Under most state workers compensation systems, you must report the work accident and injury to your employer within a specified time limit. If you wait too long to notify your employer, then you give up your right to wage loss payments and medical benefits – even if you file a workers comp claim within the applicable statute of limitations. A missed deadline lowers the settlement value of your case.

 

Reporting your work accident within the time limit set forth in the Workers Compensation Act is not the only notice requirement. Your first report of accident must also include several details about the accident and injuries.

 

As a workers compensation lawyer for injured employees and their families, nothing frustrates me more than seeing an employer and its insurance carrier avoid liability because an unrepresented employee was unaware of the notice requirement or forgot to include every detail needed. That’s why I wrote this article. To help injured workers understand the reporting requirements after a work accident – and to satisfy those requirements.

 

Below is a sample workplace accident report letter you can complete and give to your employer to satisfy the notice requirements under Virginia workers compensation. Though this letter may satisfy the workers comp notice requirements in your state, make sure you consult with a local attorney before relying on it.

 

If you have any questions, or are looking for a top-rated workers comp attorney, call me at 804-251-1620 or 757-810-5614. I’ve helped hundreds of injured workers navigate all aspects of the workers comp claims process. And I want to help you get the benefits you deserve and negotiate a top-dollar workers compensation settlement.

 

Letter Reporting Your Work Accident and Injuries to the Employer – Sample Accident Report Form

 

Name of Supervisor
Title
Employer Name
Address

 

Dear (Name of Supervisor) :

 

Please accept this letter as written notice that on (date) at (time) I was involved in a work accident. I was hurt when I (give details about what happened. For example, whether you were hurt in a fall from a heightslip and fall accident or motor vehicle accident while on the clock, or were injured due to overexertion or something else).

 

Immediately after the accident, I spoke with (name of person with whom you spoke) and reported what happened. I also (tell what actions you took post-accident, such as obtaining medical treatment). I am in the process of having my injuries evaluated. Based on my treatment regimen thus far, it is my understanding that I suffered the following injuries: (list the body parts injured, not just the specific injury or diagnosis. It is better to be general and broad in describing the injuries, so that you get more diagnoses covered).

 

My medical provider has (put me on light duty/restricted me from all work). I have received the following restrictions (list restrictions) from (doctor’s name). Please tell me if you can accommodate my restrictions. If so, I ask for a written letter detailing my new job duties post-accident.

 

My follow-up appointment is on (date). I would, however, appreciate it if you would provide a panel of physicians with whom I may treat.

 

Due to uncertainties regarding my recovery and the type of treatment I may require in the future, it will be necessary for me to file a workers’ compensation claim. Please let me know who our workers compensation insurance carrier is and the best way for me to file a claim with the carrier. I would also appreciate it if you sent me a copy of any reports or forms you have already completed because of this workplace accident.

 

Thanks for your assistance. If you need any information from me or wish to speak with me regarding the accident, my injuries, and my restrictions, contact me at your convenience. I look forward to working with you through this time.

 

Sincerely,

 

(Your name)

 

Keep at least two copies of this accident report letter. You will want to keep a copy for your records. And your attorney will want a copy in case the employer and its insurance carrier defend the claim on the basis that you failed to give timely notice of the accident or occupational illness.

 

Contact An Experienced Workers Comp Attorney Who Can Help You Notify Your Employer of Your Injuries and Win Your Case

 

At best the workers comp claims process is long and frustrating. At worst the Workers Compensation Commission may deny your claim because you failed to satisfy all the procedural requirements of the Act. This will leave you without income replacement necessary to pay your bills and medical care necessary to recover. Don’t let this happen to you.

 

From writing a letter reporting your work injury to getting the appropriate medical treatment and disability payments authorized to representing you at trial before a judge, I’m ready to help. Call 804-251-1620 or 757-810-5614 for a free consultation. Countless issues and disputes can arise when trying to get – and keep – Virginia workers compensation benefits. Hiring an experienced attorney can help you win these disputes – or avoid them entirely so that you receive wage loss checks, permanent partial disability benefits, and medical treatment without interruption.

Corey Pollard
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