Workers' Compensation Reporting Procedures – Managers
- Immediately notify HR of the accident, injury or illness report.
- Obtain a First Report of Injury or Illness form [LES Form DWC-1 (11/94)] by downloading the document from http://www.fhmic.com/policy4.php.
- Complete and submit the form within 24 hours of receiving an accident, injury or illness report. The form can be submitted to FHMIC online, or by fax at (407) 352-5788. Or call (888) 346-3461 Ext. 353.
1. Federal Employer ID Number (EIN 52-1007762).
2. FHMIC Policy Number.
3. Did the employee return to work?
4. Do you agree with the employee's description of the accident/incident?
5. Name of the hospital or physician where you referred the employee for treatment.