The Claims Process

WSI encourages you to work with your employer when filing a claim. A claim should be filed immediately after a work-related injury occurs, or within 24 hours of occurrence by completing the First Report of Injury (FROI).

WHAT TO EXPECT FROM WSI
  • WSI registers a claim when a First Report of Injury (FROI) is received and a claim number is generally assigned within 24 hours.
  • You will receive a letter informing you of the name of your claims adjuster and your claim number. This letter informs you that your claim has been received and registered.  A decision to accept or deny the claim has not yet been made. Please provide this claim number when contacting WSI, or your medical provider.
  • The claims adjuster will review the facts and gather any additional information needed to make a decision to accept or deny the claim based on North Dakota law. A notice informing you of claim acceptance or denial will be mailed to you and your employer.
CLAIM DECISION

One of the following decisions will be made on your claim:

  • Accepted: You and your employer will receive a notice of decision that WSI is accepting your claim. If you are eligible for wage-loss benefits you will receive payments that are not taxable. We will periodically mail you an injured worker income and work status letter (FL214), which you must complete and submit to WSI so there is no interruption in your wage-loss benefits. When visiting your doctor, take along a Capability Assessment form (C3) that you have received from us. After your doctor has completed the form, mail one copy to WSI, have your doctor keep one copy, and provide your employer with a copy so they are aware of your medical status.
  • Denied: You and your employer will receive a notice of decision that WSI is denying your claim.  The decision is mailed to you and your employer and it provides the reasons for the denial. If you disagree with the decision on your claim, you can send a request for reconsideration to WSI.
WORKER'S RESPONSIBILITY
  • You are responsible to minimize your disability.  Ask your doctor if you have restrictions and what they are.  Follow all restrictions, both on and off the job.
  • Keep in touch with your employer and provide them with periodic updates on your condition. At the completion of each medical appointment, your doctor will complete a Capability Assessment form (C3). For each medical appointment provide your employer with a copy of this form.
  • Notify WSI immediately if:
    • You perform any type of work activity whether you receive pay or not
    • You change your address or telephone number
    • You apply for either Social Security disability or retirement benefits or are found to be eligible for these benefits
    • The status of your dependent’s changes, i.e. birth of child, school graduation, adoption
EMPLOYER'S RESPONSIBILITY

Your employer is required to file a FROI form with WSI within 7 days of receiving notice of an injury from an employee. If we do not receive that form, we contact the employer to obtain a signed FROI. If WSI does not receive the form from the employer, WSI will waive the employer's section of the FROI and process the claim without it.

CONFIDENTIALITY

Most information contained in a claim file is confidential and is not open to the public. WSI may provide information to health care providers who are treating you or advising WSI. This may include vocational case managers, nurse case managers, and your employer at the time of your injury. Additionally, you can grant file access to anyone you wish.

Information that is available to the public (upon request) is your name; date of birth; injury date; employer name (at the time of injury); type of injury (the body part injured); whether the claim is accepted, denied, or pending (claim status); and whether the claim is in active or inactive pay status.

PRESUMPTION LAW

Any condition or impairment of health of a full-time paid firefighter or law enforcement officer caused by lung or respiratory disease, hypertension, heart disease, or exposure to blood borne pathogens as defined by North Dakota Century Code § 23-07.5-01 and 23-07.5-02, or occupational cancer in a full-time paid firefighter, is presumed to have been suffered in the line of duty. Full-time North Dakota Parks and Recreation department personnel appointed to peace office status by the director of the North Dakota Parks and Recreation are included in the presumption statute. 

See North Dakota Century Code § 65-01-15.1 for further additional conditions and exceptions.

RE-OPENING A PRESUMED CLOSED CLAIM

A claim is presumed closed if WSI has not paid any benefits for a period of 4 years.  If you are experiencing symptoms relating to a prior compensable claim, you may be eligible for reinstatement of benefits. To reopen a presumed closed claim, you must provide clear and convincing medical evidence that the original compensable injury is the primary cause of your current symptoms.

To file for reinstatement of benefits, write a letter explaining the circumstances of your condition or contact your claims adjuster to discuss.  If benefits are reinstated, medical and disability benefits can only be paid for the 30 days prior to the date your written request is received by WSI.

APPEAL A DECISION

When WSI makes a formal decision it mails an administrative order.  This order explains the decision to pay or deny benefits. If you disagree with the decision on your claim, you can request a review by the Decision Review Office within 30 days of the date of the decision.