Contents
The Illinois Form 45, known as the Employer's First Report of Injury, serves as a crucial document for employers in the state. This form must be completed promptly following any work-related injury or illness, particularly when it results in lost workdays. It collects essential information, including the employer's details such as the Federal Employer Identification Number (FEIN), business nature, and workers' compensation insurance information. The form also requires specific employee information, including their name, Social Security number, birthdate, and job title. Critical details about the incident are captured, such as the date and time of the accident, the nature of the injury, and whether the accident occurred on the employer's premises. Additionally, the form asks for information about medical treatment received, including the name of the healthcare professional involved. Employers must understand that filing this report is not an admission of liability under the Workers' Compensation Act, and the information remains confidential. Adhering to these reporting requirements is essential for compliance and ensures that employees receive the necessary support following workplace injuries.
Things to Know About This Form
What is the Illinois Form 45?
The Illinois Form 45 is the Employer's First Report of Injury. This form is used by employers to report work-related injuries or illnesses to the Illinois Workers' Compensation Commission. It collects essential details about the incident, the employee, and the nature of the injury or illness.
Who needs to fill out the Illinois Form 45?
Employers in Illinois must complete the Form 45 when an employee suffers a work-related injury or illness. This requirement applies to all employers, regardless of the size of their business or the number of employees.
What information is required on the form?
The form requires various details, including the employer's information, employee's personal information, details about the accident, and the nature of the injury. Specific items include the employer's FEIN, employee's name and Social Security number, date and time of the accident, and a description of the injury.
Is the Illinois Form 45 confidential?
Yes, the information provided on the Illinois Form 45 is confidential. Employers must handle the form and its contents with care to protect the privacy of the employee involved in the incident.
What constitutes a lost workday case?
A lost workday case occurs when an employee is unable to work for more than three scheduled workdays due to a work-related injury or illness. Employers must indicate whether the case is a lost workday case on the form.
What should an employer do if the employee dies as a result of the accident?
If the employee dies due to the work-related accident, the employer must provide the date of death on the form. This information is crucial for the Workers' Compensation Commission to process any claims related to the incident.
How is the form submitted?
Once completed, the Illinois Form 45 should be sent to the Illinois Workers' Compensation Commission at their Springfield address. Employers should ensure that the form is submitted promptly to comply with reporting requirements.
What happens if an employer fails to file the form?
If an employer fails to file the Illinois Form 45 when required, they may face penalties or fines. Additionally, not reporting injuries can impact the employer's workers' compensation claims and overall liability under the Workers' Compensation Act.
Can an employer be held liable if they file the form?
Filing the Illinois Form 45 does not affect the employer's liability under the Workers' Compensation Act. The form serves as a report and is not an admission of liability. Employers should be aware that the information provided is used to assess claims but does not incriminate them.
Where can I find more information about workers' compensation in Illinois?
For more information about workers' compensation in Illinois, employers can visit the Illinois Workers' Compensation Commission's website. They provide resources, guidelines, and additional forms related to workplace injuries and claims.
Key takeaways
Here are some key takeaways about filling out and using the Illinois 45 form:
- Accurate Information is Essential: Employers must provide correct details about the employee, the incident, and the injury. This includes names, dates, and descriptions.
- Timeliness Matters: The form should be submitted promptly after an injury occurs, especially if it results in lost workdays. Delays can complicate the process.
- Confidentiality is Protected: The information submitted is confidential. Employers should handle it with care to maintain privacy.
- Not an Admission of Liability: Completing the form does not imply that the employer is accepting responsibility for the injury. It is simply a report of the incident.
- Submission Location: The completed form must be sent to the Illinois Workers' Compensation Commission at the specified address to ensure proper processing.
Common mistakes
-
Inaccurate Employer Information: One common mistake is providing incorrect details about the employer. Ensure that the Employer's FEIN and name match official records. Any discrepancies can delay processing.
-
Missing Employee Details: Failing to include the employee's full name, Social Security number, or birthdate can lead to complications. These details are crucial for identifying the employee in the system.
-
Incomplete Accident Description: It’s vital to provide a thorough account of the accident. Simply stating that an accident occurred without explaining what the employee was doing or how it happened can result in confusion and delays.
-
Neglecting to Indicate Lost Workdays: If the case involves lost workdays, this must be clearly marked. Not indicating whether it’s a lost workday case can affect the benefits the employee may receive.
-
Failure to Provide Treatment Information: Omitting details about the medical treatment received, including the name and address of the physician or healthcare professional, can hinder the claims process. This information is essential for verifying the injury and treatment.
-
Not Signing the Report: Lastly, neglecting to sign the report can render it invalid. The signature of the person preparing the report is necessary to authenticate the information provided.
How to Fill Out Illinois 45
Filling out the Illinois Form 45 is an important step in reporting a workplace injury. Once completed, the form needs to be submitted to the Illinois Workers' Compensation Commission. This process ensures that necessary information is documented and can help facilitate any claims related to the injury.
- Type or print clearly in the spaces provided.
- Enter the Employer's Federal Employer Identification Number (FEIN).
- Fill in the Employer's name.
- Provide the date of the report.
- Input the case or file number.
- Indicate whether this is a lost workday case by selecting Yes or No.
- Write the name the employer does business as.
- Include the Employer's mailing address.
- Describe the nature of the business or service.
- Input the Standard Industrial Classification (SIC) code.
- Provide the name of the workers' compensation carrier or administrator.
- Enter the policy or contract number.
- Indicate if the employer is self-insured by selecting Yes or No.
- Fill in the employee's full name.
- Provide the employee's Social Security number.
- Enter the employee's birthdate.
- Input the employee's mailing address.
- Provide the employee's email address.
- List the number of dependents.
- Input the employee's average weekly wage.
- Select the employee's gender: Male or Female.
- Indicate the employee's marital status: Married or Single.
- Fill in the employee's job title or occupation.
- Provide the date the employee was hired.
- Input the time the employee began work.
- Enter the date and time of the accident.
- Provide the last day the employee worked.
- If applicable, enter the date of death of the employee due to the accident.
- Indicate whether the accident occurred on the employer's premises by selecting Yes or No.
- Provide the address where the accident occurred.
- Describe what the employee was doing when the accident occurred.
- Explain how the accident occurred.
- Detail the injury or illness sustained.
- List the part of the body affected and explain how it was affected.
- Identify any object or substance that directly harmed the employee.
- Provide the name and address of the physician or health care professional.
- If treatment was given away from the worksite, list the name and address of that location.
- Indicate if the employee was treated in an emergency room.
- Indicate if the employee was hospitalized overnight as an inpatient by selecting Yes or No.
- Fill in the name of the person preparing the report.
- Provide the signature of the person preparing the report.
- Enter the title and telephone number of the person preparing the report.
- Send the completed form to the Illinois Workers' Compensation Commission at 701 S. Second Street, Springfield, IL 62704.
Other PDF Forms
Illinois Epass - Maintain the integrity and security of sensitive information effortlessly.
Illinois Real Estate Transfer Tax - Accurate completion of this form contributes to the transparency of property transactions in Illinois.