Employer Coverage Kit
Statement of Benefit Payments - Effective October 1, 2012 the Employer Statement of Benefit Payments will no longer be mailed and will only be available online. To access this statement, please log on to your Online Employer Account where you may view and print monthly statements. Please contact our office if you have any questions.
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This section contains information provided in the employer coverage kit. This will provide you with valuable information regarding workers'
compensation as well as information in starting or expanding your business in North Dakota.
Welcome Letter -
This is a greeting from the staff of Workforce Safety and Insurance.
Verification of Non-Employment Form (Printable)
Insurance Coverage Requirements for Out-of-State Employers
- This will provide employers with a reference sheet of information they can keep in a workers' compensation file when they need to refer to
some basic information on obtaining coverage, payroll reporting, premium payment options and obtaining proof of coverage.
Online Services - Online services provide you with a complete list of our online services and to highlight a few: How to apply for insurance, the steps for filing a claim and the early reporting forms to use in order to avoid assessment costs, the annual payroll reporting process, how to review your employer account activity, a method of checking whether an employer has coverage with WSI, the method of requesting a premium quote, access to our employer grant program and much more.
Checklist of State Agencies for New Businesses - This is one more way that WSI works in cooperation with other state agencies in providing all new business owners a contact list to ensure they are in compliance with those agency requirements.
Important Notice of Workers Poster - WSI provides this poster to all employers so they have a visual for their employees. It covers the basic details of workers' compensation that would be helpful for the worker if they suffer an injury and what type of benefits they can receive.
First Report of Injury Instructions - Guidelines of when and how you should report an injury to WSI. WSI encourages a claim to be filed within 24 hours of injury occurrence. Using this online function will expedite the process and allow for more effective claims management.
First Report of Injury Form - This is the form used to report an injury to WSI. It should be completed as soon as possible after an injury occurs. It can be completed by the medical provider, employer or employee and it expedites the process when a claim needs to be filed due to a work related injury.
Early Claim Reporting Incentive Letter - Explains the steps and timeline recommended to ensure that the employer saves on claim costs and the injured worker receives the best medical care and support possible. Check out this win/win solution.
Tips for Reducing Workers' Compensation Costs - This fact sheet covers many of the ways employers can use safety in the workplace to reduce injuries. It informs you of what programs WSI has in place to assist you with this process and the timeframes and options for reporting injuries.
Fraud Prevention Tips for Employers - This will educate employers on how to recognize possible signs of fraud in the workplace and ways to prevent it by staying involved in the day to day operations. Communication and trust with your employees is one sure way to get their commitment to help control fraudulent situations.
Near Miss Reports and Investigations - All workplaces have situations happen that may not result in an injury or property damage but have that potential. This information will assist the employer in having a "near miss" report system in place, allowing employees to report and have unsafe situations addressed. Hopefully this will prevent a second occurrence or possible serious injury from occurring.
Safety Incentive Programs - WSI invites every North Dakota employer to “put safety to work” by implementing one of these safety programs at their workplace. These programs can reduce a qualifying employer’s premium by up to 25%. Matching grants can also be obtained to assist in purchasing safety interventions that eliminate ergonomic workplace hazards. In addition associations and employee organizations may qualify for grants to help promote safety through training and education.
Small Account Credit/Debit Program - This online brochure explains the details of this program. The goal of the program is to create incentives for small businesses to manage their claims and implement safety programs.
Certificates - Workforce Safety & Insurance (WSI) issues Certificates of Premium Payment to all active policyholders who are current with their premium payments. Previously, certificates were issued for the entire policy upon receipt of the required minimum installment. Effective June 2013, WSI changed this policy to better reflect an expiration date that coincides with the amount of the payment.
Upon receipt of the minimum payment a certificate will be issued for 60 days. Each subsequent minimum payment will generate a certificate for 60 days. If payment of the entire balance is received the certificate will be issued for the full policy period.