Use: Reporting claims by Employer to Carrier.
Filing Requirements:
Employer: Reporting all cases, except 1st aid cases to the carrier with in 7 days
of knowledge of the injury or accident. If the 1st aid claim becomes a medical
only or lost time claim, then the employer shall report with in 7 days of knowledge. The information on the form may be called in or faxed in to the carrier. The form should not be delayed because the employee signature is not available.
Statutory or Rule governing: 69L – 3.004, 3.0045.
Comments: the division assesses Penalties if the form is not filed timely in all cases. Penalties are days 1-7 $100.00, days 8-14 $200.00, days 5-21 $300.00, days 22-28 $400.00; & 28 days & over are $500.00. Issues can be responded to in letterform to the division asking for ‘reconsideration of the penalty’ with a detailed explanation of why the NOI was not timely.
