Ala. Admin. Code r. 480-5-1-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 480-5-1-.01 - Reporting Instructions For Insurance Companies And Self-Insured Employers For Workers' Compensation Claims

(1) WCC 2 - Employer's First Report of Injury - Forward one completed copy signed in ink to the above address within fifteen (15) days for all injuries for which compensation is claimed or paid. This includes deaths, permanent disabilities, and temporary disabilities exceeding three (3) days.

(2) WCC 3 - Supplementary Report - Forward one copy signed in ink to the above address with the applicable section or sections completed within ten (10) days following:

A. The date of first payment of compensation after the initial claim or the date of first payment after previous payments were stopped or interrupted for any reason.

B. The expiration of a thirty-day period of nonpayment of compensation after the employer has knowledge of a claim.

C. The date of cessation or termination of payment of compensation, for any reason whatever, including the interruption or suspension of periodic payments.

(3) WCC 4 - Final Report and Settlement Receipt - Forward one completed copy to the above address within ten (10) days if possible, but in no case later than thirty (30) days, after the last or final payment of compensation has been made. Enter the amount of medical expenses paid as of the date of the report. If compensation payments are resumed, complete Section A of WCC Form 3 and file within ten (10) days. If additional compensation is claimed, but is not paid within thirty (30) days, complete Section B of WCC Form 3 and file within ten (10) days after the expiration of such thirty-day period.

(4) WCC 5 - Surgeon's Report - Required only upon specific request by this Department. The use of similar forms is permissible.

(5) One of the purposes of the above reports is to keep this department advised at all times of the current status of any claim. If the reporting forms do not contain items fully explaining the current status of a claim, a note of explanation should be made on or attached to the report.

(a) Reporting forms other than the Employer's First Report of Injury must be signed in ink by the adjuster in charge of the claim.

(b) Incomplete reports, illegible reports, or reports filed on unapproved forms will not be accepted.

(c) Reporting forms may be reproduced or purchased from a private printing company.

Author: Randy Richie, Workers' Compensation Director

Ala. Admin. Code r. 480-5-1-.01

Previous Rule effective September 30, 1982; Effective February 16, 1993.

Statutory Authority:Code of Ala. 1975, § 25-2-2(6).