Chambers Brown Law

For Employers & Insurers

Disability Status Report

First Report of Injury - Initial form used to report all work-related injuries. Must be filed by the Insurer through the EDI if the claim exceeds the three-day waiting period or results in permanent partial disability.

Health Care Provider Report - This form is commonly sent to the treating doctor to determine if the employee has reached maximum medical improvement and/or qualifies for a permanent partial disability rating. Health care providers must complete the form and return it to the requesting party within 10 days of receiving the request.

Notice of Benefit Payment - This form is typically used to notify the Employee that benefits have been paid, including payment of permanent partial disability, payment per an award or order, or to provide the employee with a summary of all benefits paid on the claim.

Notice of Benefit Reinstatement - This form is used to notify the Employee that benefits have been reinstated following a discontinuance and must be used when reinstating TTD, TPD, PTD or dependency benefits.

Notice of Intention to Discontinue (NOID) -

Notice of Primary Liability Determination

Objection to Penalty Assessment

Minnesota Treatment Parameters (MN DLI)

Treatment Parameters
Reference Guide – contact us

WCRA Calculators (Workers’ Compensation Reinsurance Association) - These are very handy calculators you can use to calculate indemnity benefits, permanent partial disability, temporary partial disability, number of weeks in a period, interest, and life expectancy.

Resources

For Injured Workers

For Employers & Insurers

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