Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES *If you need to send an email to the employer. The list of questions is in the templates. Please attempt to contact by phone initially and send an email only if you cannot communicate by phone or if the employer prefers email. Always request the following documentation: Internal First report of injury, safety investigation, medical note(s), work slips, etc. Initial Injured Worker Contact – Note Category “Injured Worker – Contact” (Use Recorded Statement Template to gather information but document in summary) Injured Worker: I called and spoke with the IW, Raymond Stevens. He prefers to be contacted by text message, so I confirmed his phone number. He is 6’ 2” tall and weighs 220 pounds. He is right-hand dominant, with brown hair with blue eyes. He does not wear glasses. I confirmed his date of birth as 1/7/62 and his address as 309 S. Prairie St, Below, AZ. He is married and has two sons over the age of 18. He speaks English. He has a high school education with trade school experience but is not a licensed electrician. He has worked for KBL Design Center as a light fixture installer and service technician for 17 years. His supervisor is Matt Gibson. He works 8 hours per day, 40 hours per week. He works the daytime shift. He makes $25 per hour. He does not have any concurrent employment, and before working for KBL, he worked for the City of Below as a laborer. He does not have any medical conditions and no history of any prior surgeries. He does have group health insurance through KBL Design and has never applied for Medicare or Medicaid. His hobbies outside of work include deer hunting with a shotgun and no bow. Accident Raymond reports he was injured on 7/22/22 when he cut his hand while removing a light fixture from the packaging. He was on-site at a customer location when the incident occurred. The only witness was the customer, Louisa Bell. He cut his right hand. No other injuries. He called his supervisor right away while bandaging the hand. His supervisor picked him up at the customer location of 609 S. Timber St., Below, AZ, and drove him to Mercy Hospital in Phoenix, AZ. He was admitted into the emergency room and treated with 23 sutures. He explained he cut his hand with a box cutter. He did not feel there was anything wrong with the box cutter. He confirmed the diagnosis as a laceration to the palm of the right hand. He was referred to a hand specialist for follow-up – Dr. Clyde Grady with the Mercy Medical Professional Building in Phoenix, AZ. His next appt is scheduled for 8/1/22. He lost two days of work on 7/23 & 7/24, returning to work on 7/25. He has an off-work slip from the emergency room. He was drug tested at the ER also. I explained his benefits for the state of AZ and sent him an employee brochure by email. He will forward his off-work slip to me by email, and we will continue to communicate by text message. Explained WC benefits and Rx/medical bill review process. Also provided state references as a resource. NARS’ Best Practices were created by and for the internal use of NARS and are confidential, proprietary and trade secret documents protected by the Uniform Trade Secrets Act and applicable state/federal law. They may not be copied, distributed, or reproduced, in whole or in part, without NARS’ express prior written authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.