Treating an Injured Employee

WSI offers three ways for injured employees, employers, and medical providers to submit claims information. We encourage you to work with the injured employee when completing claims forms.

• Claim Filing - Injured employees, employers, and medical providers may complete forms electronically.
• Complete a First Report of Injury (FROI) Form - Injured employees, employers, and medical providers may complete forms by hand and either mail the forms to us or fax them to us at (701) 328-3820.
  Complete instructions are available for completing the FROI form by hand.
• Telephonic Filing - Injured employees, employers, and medical providers may report a claim 24 hours a day, 7 days a week by calling (701) 328-3800 or 1-800-777-5033.

All parties (meaning the injured employee, medical provider, and employer) may complete and sign one form or each party may complete an individual form and mail or fax to WSI or complete a form online.

You play a very important role in helping us assist injured employees. To help us provide the injured employee with the benefits they deserve, please follow these guidelines:

1. Provide prompt and appropriate care to the injured employee.
2. Evaluate the injury and develop an appropriate treatment plan that includes using the job as part of the recovery process.
3. Provide medical reports that are prompt and complete (within 24 hours of the appointment). NOTE: Complete the Capability Assessment form (C3) (also known as the Workability Assessment Report or Progress Report), each time you see the injured employee during the acute phase of the injury. This form is used after the injury occurs to provide a medical update on the injured employee's condition. Your return-to-work indication on this form is used to authorize wage replacement benefits for the injured employee.
4. Establish appropriate restrictions and focus on the injured employee's abilities rather than disabilities.
5. Share in the employer's goal of keeping the injured employee at work (using transitional work, when necessary), and share in the understanding that the employee's abilities must meet the job functions.
6. Establish and maintain communication with the injured employee, employer, and WSI.
7. If you are selected as an employer's designated medical provider (DMP), acquire knowledge about the employer's business operations and employee's job functions.
8. Maintain primary responsibility for the direction of the medical management on the claim, including referrals to specialists.
9. Support the managed care process (ensuring quality, appropriate medical care that is cost efficient).
10. Support the utilization review process (the process of evaluating proposed medical services for efficiency, appropriateness, and medical necessity).
11. Attend educational seminars provided by WSI to learn about new programs and processes and to share ideas.

Required forms:

First Report of Injury (FROI) form. This form needs to be completed when an injured employee is first seen for a work-related injury. Complete instructions are available for completing the FROI form by hand.

Capability Assessment form (C3) (also called the Workability Assessment Report or Progress Report). This form needs to be completed each time you see the injured employee during the acute phase of injury.

No decision can be made on any claim until all required information is received.