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12:00:09 AM CDT
Friday, April 25, 2014

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Treating an Injured Worker

Topics ICD-9 Forms & Publications Medical Provider's Guide
Treating An Injured Worker Treatment Guidelines First Report of Injury (FROI) Form  
Claim Information Claim Number Lookup Capability Assessment form (C3)  
Medical Treatment Medical Provider Appeal Process Medical Services Dispute Resolution Request (M2)  
Subsequent Treatment   Provider Request for Adjustment (M6) form  

Claim Information
It is required a claim be filed by one of the three methods:

WSI will inform the injured worker of their claim number in writing upon registering the claim. If the claim is filed online, a claim number will immediately be assigned. The assigned claim number is only a confirmation of the claim being registered. All pertinent information relating to the injury will need to be received and applied to North Dakota statutes for a decision of either acceptance or denial.

A claims adjuster is assigned to the claim and starts to review the information within 24 hours of receiving a completed claim form. There are two types of claims:

  • Medical only claim If the injured worker is off work for fewer than five calendar days in a row; or if there is no loss of earning, the claim is a medical only claim.
  • Time-loss claim If the injured worker is off work five or more consecutive calendar days and there is a loss of earnings, the claim is a time-loss claim.

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