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When Death Occurs Due to an Injury at the Workplace

Within 1 day after the death of an employee due to a compensable injury, report the death to the division and the employer's insurance carrier by phone, letter or email listed on this page.

Essential Injury Report Facts

An insured employer must notify its insurance carrier of a compensable injury within 7 days after the accident or beginning of a disability from occupational disease related to the employee's compensable injury if any of the following occurs:

  • Disability exists beyond the 3rd day after the employee leaves work because of the accident or disease. In counting the days on which disability exists, include Sunday only if the employee usually works on Sunday.
  • An employer's insurance carrier has primary liability for unpaid medical treatment.

Please include the Worker's Compensation Division's claim number or the Social Security number of the worker on all correspondence, compensation reports and medical reports.

Form WKC-12-E: Employer's First Report of Injury or Disease