The Illinois Form 45 is the Employer's First Report of Injury, a crucial document that employers must complete when a work-related injury occurs. This form gathers essential information about the incident, the employee, and the nature of the injury. Timely and accurate reporting helps ensure compliance with state regulations and supports the employee in accessing necessary benefits.
The Illinois Form 45, known as the Employer's First Report of Injury, serves a critical function in the realm of workplace safety and workers' compensation. This form must be completed by employers to document work-related injuries and illnesses, particularly those that result in the loss of more than three scheduled workdays. Key information included on the form encompasses the employer's details, such as the Federal Employer Identification Number (FEIN), name, and mailing address, alongside the nature of the business and workers' compensation coverage. Additionally, the form requires comprehensive details about the injured employee, including their full name, Social Security number, birthdate, and average weekly wage. It also captures specifics about the incident, such as the date, time, and location of the accident, as well as a description of the injury and the circumstances surrounding it. Employers must indicate whether the incident occurred on their premises and provide information about any medical treatment received. The form must be submitted to the Illinois Workers' Compensation Commission, ensuring that the employer complies with legal obligations while maintaining confidentiality regarding the reported information. By accurately completing and filing this form, employers fulfill their responsibility to document workplace injuries and facilitate the necessary support for affected employees.
What is the Illinois Form 45?
The Illinois Form 45, also known as the Employer's First Report of Injury, is a document that employers must complete when an employee experiences a work-related injury or illness. This form captures essential information about the incident, including details about the employee, the nature of the injury, and the circumstances surrounding the accident. It is a crucial step in the workers' compensation process.
When should the Illinois Form 45 be filed?
This form must be filed when an employee suffers an injury that results in the loss of more than three scheduled workdays. Employers are required by law to report all significant work-related injuries to the Illinois Workers' Compensation Commission. Timely submission ensures compliance and helps facilitate the workers' compensation claims process for the injured employee.
What information is required on the Illinois Form 45?
The form requires various details, including the employer's information, the employee's personal information, and specifics about the accident. Key sections include the date and time of the accident, the nature of the injury, and any medical treatment received. Additionally, employers must provide information about the employee's job title, average weekly wage, and whether the accident occurred on the employer's premises.
How is the Illinois Form 45 submitted?
Once completed, the Illinois Form 45 should be sent to the Illinois Workers' Compensation Commission at their Springfield address. It is important to ensure that the form is filled out accurately and completely to avoid delays in processing the claim. Employers should also keep a copy for their records, as this information is confidential and essential for future reference.
Neglecting to provide the employer's FEIN: The Federal Employer Identification Number is crucial for identifying the employer. Without it, the report may be delayed or rejected.
Failing to accurately describe the accident: A vague description of how the accident occurred can lead to misunderstandings. It is important to provide clear and detailed information.
Omitting employee details: Missing information about the employee, such as their full name, Social Security number, or mailing address, can cause significant delays in processing the report.
Not indicating if the case involves lost workdays: This information is essential for the Commission to determine the severity of the case and the employer's obligations.
Inaccurate reporting of the injury: Failing to list the specific part of the body affected or how it was harmed can lead to complications in claims processing.
Forgetting to include the date and time of the accident: This information is vital for establishing a timeline and understanding the context of the incident.
Not providing the name of the workers' compensation carrier: This detail is crucial for ensuring that the employee receives the necessary benefits and medical care.
Submitting the form without a signature: A signature from the person preparing the report is required. Omitting this can render the report invalid.
ILLINOIS FORM 45: EMPLOYER'S FIRST REPORT OF INJURY
Please type or print.
Employer's FEIN
Employer's name
Date of report
Case or File #
Is this a lost workday case?
Yes / No
Doing business as
Employer's mailing address
Nature of business or service
SIC code
Name of workers' compensation carrier/admin.
Policy/Contract #
Self-insured?
Employee's full name
Social Security #
Birthdate
Employee's mailing address
Employee's e-mail address
# Dependents
Employee's average weekly wage
Male / Female
Married / Single
Job title or occupation
Date hired
Time employee began work
Date and time of accident
Last day employee worked
If the employee died as a result of the accident, give the date of death.
Did the accident occur on the employer's premises?
Address of accident
What was the employee doing when the accident occurred?
How did the accident occur?
What was the injury or illness? List the part of body affected and explain how it was affected.
What object or substance, if any, directly harmed the employee?
Name and address of physician/health care professional
If treatment was given away from the worksite, list the name and address of the place it was given.
Was the employee treated in an emergency room?
Was the employee hospitalized overnight as an inpatient?
Yes
/ No
Report prepared by
Signature
Title and telephone #
Please send this form to the ILLINOIS WORKERS' COMPENSATION COMMISSION
701 S. SECOND STREET SPRINGFIELD, IL 62704. IC45 12/04
By law, employers must keep accurate records of all work-related injuries and illness (except for certain minor injuries). Employers shall report to the Commission all injuries resulting in the loss of more than three scheduled workdays. Filing this form does not affect liability under the Workers' Compensation Act and is not incriminatory in any sense. This information is confidential.
When filling out the Illinois Form 45, it is important to follow specific guidelines to ensure accuracy and compliance. Here are some things you should and shouldn't do:
The Illinois Form 45 serves as the Employer's First Report of Injury, primarily used to report workplace injuries to the Illinois Workers' Compensation Commission. Alongside this form, several other documents are commonly utilized in the workers' compensation process. Each document plays a crucial role in ensuring compliance and facilitating communication between involved parties.
These documents collectively contribute to the effective management of workers' compensation claims in Illinois. They ensure that all parties involved have the necessary information to address injuries promptly and accurately, promoting a fair resolution process.
Here are five common misconceptions about the Illinois Form 45, the Employer's First Report of Injury:
This is incorrect. The Illinois Form 45 must be filed for any work-related injury that results in lost workdays, regardless of the severity of the injury.
Filing the Illinois Form 45 does not imply that the employer is admitting liability. It is simply a reporting requirement under the Workers' Compensation Act.
This is false. Employers are legally required to file this form for any injury that results in the loss of more than three scheduled workdays.
In fact, the information provided on the Illinois Form 45 is confidential and protected under the law.
While prompt reporting is encouraged, employers have a specific timeframe within which to submit the form after the injury occurs. It's important to check the exact requirements.
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