Checklist · Labor and Employment

Handling a Workplace Injury and Workers' Compensation Claim: A Practical Checklist

42 U.S.C. § 1395

Type: Checklist
Jurisdiction: National
Date: 2025-02-04
Topic: Labor and Employment

An incident-forward checklist covering a workplace injury from the first hour through settlement, written so an employer, a carrier, and claimant counsel can each work their half. Phases one through four cover the first week: medical care and scene preservation, notice and reporting to the carrier and the agency, evidence preservation including the third-party screen that has to happen before equipment is repaired, and the compensability investigation that supports an accept-or-deny decision. Phases five through nine cover claim administration: the accept or deny decision and its penalty consequences, average weekly wage computation and the components people forget, medical management and utilization review, disability status and benefit payment, and the light duty offer that suspends benefits if refused. Phases ten through thirteen cover the parallel obligations and the endgame: ADA interactive process and FMLA designation that run alongside the comp claim, maximum medical improvement and impairment rating, the third-party action and the lien and future credit that follow it, and settlement including the Medicare Set-Aside that delays most closings. Phases fourteen through eighteen cover disputes, retaliation avoidance, OSHA recordkeeping, program management, and the claimant-side sequence. A worked example runs a fictional warehouse injury through the whole file.

Handling a Workplace Injury and Workers' Compensation Claim: A Practical Checklist

Labor and Employment > Workers Compensation | Published 4 February 2025 - Updated 11 May 2026 | UpLaw - uplaw.us

Two things have to happen in the first week and almost never do. The third-party screen — because the machine gets repaired, the scene changes, and the video is overwritten. And the average weekly wage computation — because an error of sixty dollars a week compounds across years of benefits and nobody revisits it. Everything else in a comp file can be fixed later. Those two cannot.

Keywords: first report, notice deadline, compensability, AOE/COE, average weekly wage, choice of physician, utilization review, light duty, ADA interactive process, FMLA, MMI, impairment, third-party lien, MSA, OSHA 300

Work this in order. Phases 1–17 are employer and carrier side; Phase 18 is the claimant sequence. Both sides should read both. The doctrinal treatment is in Workers' Compensation: A Comprehensive Guide to Coverage, Benefits, and Claim Disputes. The narrative overview is The Grand Bargain: Why Workers' Compensation Trades Fault for Certainty.

Our running example. Petra Osei (fictional) tore her rotator cuff lifting a carton at a warehouse operated by Northgate Distribution, LLC (fictional). She used a powered lift assist that had been reported as malfunctioning twice in the prior month.

Phase 1 — The first hour

[ ] Provide or arrange immediate medical care. Nothing else outranks this.
[ ] For a serious injury, follow the emergency protocol and notify the designated responder.
[ ] Do not require the employee to complete paperwork before receiving treatment.
[ ] Direct the employee to an authorized provider if the state permits employer direction; otherwise inform them of their choice rights in writing.
[ ] Secure the scene — do not repair, move, or discard equipment.
[ ] Photograph the scene, the equipment, and any visible injury.
[ ] Identify witnesses by name and obtain contact information.
[ ] Preserve video before it overwrites — most systems overwrite in 7 to 30 days.
[ ] Note whether a post-accident test is required under policy and permitted under state law.

Why it matters, and the traps. Post-accident drug testing is constrained in several states and, for a period, was constrained by OSHA's anti-retaliation rule. Apply a written, consistently enforced policy rather than an ad hoc decision, and never test selectively.

Do not let a supervisor tell the employee "we'll take care of it, no need to file." That statement is the first exhibit in a retaliation case and it does not stop the claim.

Phase 2 — Notice and reporting

[ ] Complete the First Report of Injury and file with the carrier and the state agency within the statutory period — often within days.
[ ] Confirm the employee has given notice in the form the statute requires, and document the date.
[ ] Record the date the employee knew or should have known the condition was work-related, for occupational disease and cumulative trauma claims.
[ ] Provide the employee with the required claim forms and notices.
[ ] Confirm the posted notice with carrier information is current.
[ ] For a fatality or catastrophic injury, comply with the OSHA reporting deadlines — 8 hours for a fatality, 24 hours for an inpatient hospitalization, amputation, or loss of an eye. 29 C.F.R. § 1904.39.
[ ] Notify excess or reinsurance carriers if the claim may exceed the retention.

Why it matters, and the traps. Late reporting carries penalties in most states and interferes with early investigation, which is when the facts are recoverable. It also starts the claim on an adversarial footing.

The notice trigger for cumulative trauma is discovery of the work connection, not the onset of symptoms. Record what the employee said and when.

Phase 3 — Preserve, and screen for the third-party case

[ ] Issue a litigation hold covering the incident, the equipment, maintenance records, and communications.
[ ] Quarantine the equipment involved and do not repair it.
[ ] Collect maintenance and repair records, prior complaint reports, and inspection logs.
[ ] Identify the manufacturer, installer, and servicer of any equipment involved.
[ ] Identify other entities on site — contractors, property owner, staffing agency, delivery carrier.
[ ] Identify any motor vehicle involved and its owner and insurer.
[ ] Preserve telematics, machine logs, and access control data.
[ ] Determine whether the employer's own conduct creates contribution or indemnity exposure to a third party.

Why it matters, and the traps. The third-party action is frequently worth more than the comp claim because it carries pain and suffering, which the comp system does not provide at all. It is also the carrier's route to recovering the benefits it pays.

Northgate's malfunctioning lift assist, reported twice and not repaired, is a products claim against the manufacturer, a negligence claim against the maintenance contractor, or both. The repair records are the case, and they get discarded.

See Products Liability: A Comprehensive Guide to Design Defect, Manufacturing Defect, and Failure to Warn and Evaluating a Personal Injury Claim: A Practical Checklist.

Phase 4 — Investigate compensability

[ ] Take a recorded statement from the employee, promptly, covering mechanism, timing, prior symptoms, and prior claims.
[ ] Interview witnesses and the supervisor separately.
[ ] Confirm the employee was in the course of employment — on the clock, on premises, doing work or something incident to it.
[ ] Confirm the injury arose out of the employment — the employment exposed the employee to the risk.
[ ] If the injury occurred coming or going, apply the premises rule and the other exceptions. Obtain the lease or deed for any parking area.
[ ] Screen for the special doctrines: personal comfort, horseplay, idiopathic fall, unexplained fall, assault, recreational activity, intoxication or willful misconduct.
[ ] For a repetitive or exposure claim, determine whether it is an accidental injury or an occupational disease under the state's classification.
[ ] Identify any preexisting condition and obtain prior medical records with authorization.
[ ] Determine whether a statutory presumption applies to the condition and occupation.
[ ] Determine whether an aggravation theory applies and what the state's apportionment rule is.

Why it matters, and the traps. Investigate promptly and neutrally. An investigation that reads as an effort to build a denial produces a bad faith exposure in states that recognize one, and it produces a plaintiff's exhibit everywhere.

Do not deny for a technical notice defect without confirming the state's prejudice requirement — most states excuse late notice absent prejudice.

Phase 5 — Accept or deny

[ ] Make the decision within the statutory period, which is short.
[ ] If accepting, begin benefit payment on the schedule and note the waiting period.
[ ] If denying, issue the written denial with the specific statutory grounds, and serve it as required.
[ ] Consider a partial acceptance — accepting the shoulder while disputing the cumulative trauma theory — with clear written scope.
[ ] Consider paying without prejudice where the state permits, which preserves the denial while avoiding penalties.
[ ] Calendar the penalty exposure for late or unreasonable denial.
[ ] Confirm whether the state recognizes a bad faith claim outside exclusivity for unreasonable denial.

Why it matters, and the traps. A denial that is later reversed produces penalties, interest, attorney's fees, and in some states an independent bad faith action. Deny only on grounds you can support at hearing, and document the investigation that led there.

Phase 6 — Compute average weekly wage correctly

[ ] Identify the state's lookback period and computation method.
[ ] Include overtime at the correct rate.
[ ] Include bonuses and commissions if regular.
[ ] Include tips as reported.
[ ] Determine whether the state includes concurrent employment — a second job can materially raise the rate.
[ ] Determine whether the state includes fringe benefits — employer-paid health premiums, retirement contributions, housing.
[ ] Apply the special formula for seasonal, intermittent, or short-tenure employment.
[ ] Apply the statutory maximum and minimum.
[ ] Document the computation with the underlying payroll records.
[ ] Audit it again at the first dispute and at settlement.

Why it matters, and the traps. This computation sets every indemnity benefit for the life of the claim. It is done once, quickly, by someone with a spreadsheet, and it is almost never revisited. A $60 error in AWW is roughly $40 per week in benefits — across five years, more than $10,000, before any permanent disability multiplier.

Concurrent employment is the most commonly missed component. Ask.

Phase 7 — Manage medical care

[ ] Confirm the state's choice of physician rule and that treatment is authorized.
[ ] Provide the treating physician with a job description including physical demands, so restrictions are realistic.
[ ] Apply utilization review to proposed treatment consistently, not selectively.
[ ] Comply with treatment guidelines and the variance process where the state has adopted them.
[ ] Schedule an independent medical examination at appropriate intervals — not to harass, and not so rarely that the file has no defense evaluation.
[ ] Where available, use the agreed medical examiner or panel evaluator process to resolve conflicting opinions.
[ ] Monitor the drug formulary and opioid prescribing.
[ ] Assign nurse case management for complex or catastrophic claims.
[ ] Pay medical bills within the statutory period to avoid penalties.

Phase 8 — Pay indemnity benefits

[ ] Determine disability status: TTD, TPD, or working full duty.
[ ] Apply the waiting period and the retroactive payment threshold.
[ ] Pay on the statutory schedule — most states require payment at the employee's normal pay interval.
[ ] Track the statutory cap on temporary benefit duration if the state has one.
[ ] Adjust benefits when work status changes, with written notice as required.
[ ] Apply any offsets — unemployment, Social Security Disability Insurance, employer-funded disability plans — as the statute permits.
[ ] Document every payment and every suspension with the statutory notice.

Phase 9 — Return to work

[ ] Obtain written restrictions from the treating physician, specific and functional.
[ ] Identify modified duty within the restrictions that is genuine, productive work.
[ ] Make the offer in writing, describing the job, hours, wage, and location.
[ ] Document the employee's response.
[ ] If the offer is refused without justification, suspend benefits with statutory notice.
[ ] Monitor performance against restrictions and adjust as they change.
[ ] Provide vocational rehabilitation where required or useful.
[ ] Do not condition return on a "100% healed" or "full duty" release.

Why it matters, and the traps. A "100% healed" policy is generally unlawful under the ADA because it forecloses accommodation. It is also one of the easiest violations for a plaintiff's lawyer to establish, because it is usually written down in a handbook.

A light duty offer that is not genuine — sitting in a room counting screws — will not survive a hearing and it damages the employer's credibility on everything else.

Phase 10 — The parallel ADA and FMLA obligations

[ ] Assess whether the injury is a disability under the ADA — it frequently is.
[ ] Begin the interactive process on return with restrictions.
[ ] Consider reasonable accommodations including modified duty, schedule change, equipment, and reassignment to a vacant position.
[ ] Document the interactive process contemporaneously.
[ ] Apply direct threat analysis individually and on medical evidence, never categorically.
[ ] Designate FMLA leave so the entitlement runs concurrently with the comp absence.
[ ] Provide the FMLA eligibility, rights and responsibilities, and designation notices on time.
[ ] Keep medical information confidential and separate from personnel files.
[ ] Check state and local leave and accommodation laws, which are frequently broader.

See Handling an Accommodation Request Under the ADA: A Practical Checklist, Processing an FMLA Leave Request: A Practical Checklist, and The Interactive Process: How Reasonable Accommodation Actually Works Under the ADA.

Phase 11 — MMI and impairment

[ ] Obtain the MMI determination and the date.
[ ] Terminate temporary benefits with proper notice and begin the permanent disability analysis.
[ ] Obtain an impairment rating under the correct AMA Guides edition for the state and date of injury.
[ ] Verify the rating's methodology — wrong edition or wrong table is the most common defect.
[ ] Obtain a rebuttal rating where the treating physician's rating is unsupported.
[ ] Use the state's conflict resolution mechanism — agreed examiner, panel evaluator, or judicial determination.
[ ] Analyze apportionment to preexisting conditions or prior awards under the state's rule.
[ ] Determine whether the injury is scheduled or unscheduled and apply the correct valuation method.
[ ] Evaluate permanent total and the odd-lot doctrine for severe cases.
[ ] Obtain a vocational assessment for loss-of-earning-capacity states.

Phase 12 — The third-party action and the lien

[ ] Confirm the statute of limitations for the third-party claim, which is the tort period and is independent of the comp deadlines.
[ ] Give notice to the employee and carrier as the statute requires.
[ ] Determine who may sue — employee, carrier, or both — and the timing of any assignment.
[ ] Assert the lien with a current benefit payment ledger.
[ ] Determine whether the lien is reduced by the employee's attorney's fees and costs.
[ ] Determine whether the lien is reduced by the employer's own comparative fault.
[ ] Compute the future credit against benefits from the employee's net recovery — this is frequently worth more than the past lien.
[ ] Confirm whether the carrier's consent to settle is required and the consequence of proceeding without it.
[ ] Confirm whether the third party may seek contribution or indemnity from the employer, and whether any contractual indemnity is enforceable under the state's anti-indemnity statute.
[ ] Begin the lien negotiation early, not at mediation.

Phase 13 — Settlement and Medicare

[ ] Determine whether the state permits a compromise and release closing future medical.
[ ] Determine whether agency approval is required and what the approval standard is.
[ ] Determine whether the claimant is a Medicare beneficiary or has a reasonable expectation of becoming one.
[ ] Obtain a conditional payment letter and resolve Medicare's past payments.
[ ] Determine whether a Workers' Compensation Medicare Set-Aside is appropriate and whether CMS review thresholds are met.
[ ] Obtain the MSA allocation and negotiate its amount — this is frequently the largest component of the settlement.
[ ] Decide self-administration versus professional administration of the MSA and provide the claimant with the required instructions.
[ ] Confirm Section 111 reporting obligations under 42 U.S.C. § 1395y(b) are met.
[ ] Resolve other liens: Medicaid, ERISA plan reimbursement, health insurer subrogation, child support, and provider liens.
[ ] Consider a structured settlement, which can fund the MSA at lower present cost.
[ ] Draft the release with precise scope — which body parts, which dates, which benefits, and whether resignation or a general employment release is included.

Why it matters, and the traps. The MSA process delays settlements by months. Start it at the first mediation, not at the last. And a general release that also resolves employment claims requires OWBPA compliance for a claimant over forty. See Drafting and Closing a Settlement Agreement: A Practical Checklist and Reductions in Force and Severance: A Comprehensive Guide to WARN, OWBPA, and Separation Agreements.

Phase 14 — Dispute and hearing

[ ] Calendar every procedural deadline — request for hearing, discovery, exhibit exchange, and pre-hearing statements.
[ ] Take the deposition of treating and evaluating physicians.
[ ] Obtain complete prior medical records, including from providers the claimant did not disclose.
[ ] Use surveillance only where justified, and comply with the state's disclosure timing rules.
[ ] Prepare vocational evidence for loss-of-earning-capacity claims.
[ ] Prepare the claimant or employer witnesses for the hearing's relaxed evidentiary environment.
[ ] Preserve issues for appellate review, and note the substantial evidence standard on factual findings.

Phase 15 — Do not retaliate

[ ] Confirm no adverse action is taken because of the claim.
[ ] Require documented, contemporaneous, independent justification for any adverse action involving a claimant, reviewed before it is taken.
[ ] Apply attendance and performance policies consistently across claimants and non-claimants.
[ ] Train supervisors that discouraging a claim is itself actionable.
[ ] Note that retaliation claims are outside exclusivity and frequently carry punitive damages.
[ ] Screen any termination of a claimant through counsel.

Phase 16 — OSHA recordkeeping

[ ] Determine recordability under 29 C.F.R. Part 1904 — which is a different standard from comp compensability, and neither determines the other.
[ ] Record on the OSHA 300 log within 7 calendar days.
[ ] Complete the 301 incident report or equivalent.
[ ] Post the 300A summary February 1 through April 30.
[ ] Submit electronically if the establishment meets the reporting criteria.
[ ] Report fatalities within 8 hours and hospitalizations, amputations, and eye losses within 24 hours.
[ ] Do not maintain a safety incentive program or post-accident testing practice that discourages reporting.

Phase 17 — Program management

[ ] Audit the experience modification worksheet annually for errors — reserve overstatements and misclassified claims are common and expensive.
[ ] Review reserves on open claims and challenge overstated ones.
[ ] Confirm payroll classification codes are accurate — misclassification is premium fraud exposure as well as a cost issue.
[ ] Track claim frequency and severity by location and supervisor.
[ ] Run a return-to-work program with defined modified duty positions identified in advance.
[ ] Conduct root cause analysis on every recordable injury and close the corrective actions.
[ ] Confirm certificates of insurance from every contractor and subcontractor, at every tier, before work starts.

Phase 18 — The claimant-side sequence

[ ] Report the injury immediately and in writing, and keep a copy.
[ ] Seek medical care and state clearly that the injury is work-related.
[ ] Identify the notice and filing deadlines and calendar both.
[ ] Understand the state's choice of physician rule before treating.
[ ] Document symptoms, restrictions, and work impact contemporaneously.
[ ] Identify all wage components for the AWW computation — especially concurrent employment and regular overtime.
[ ] Screen for a third-party claim in the first month, before evidence disappears.
[ ] Screen for ADA accommodation and FMLA entitlements, which run alongside the comp claim.
[ ] Screen for retaliation if any adverse action follows.
[ ] Preserve prior medical records rather than concealing them — undisclosed prior treatment is the fastest way to lose credibility at hearing.
[ ] Before settling, understand what closing future medical means and what an MSA will and will not cover.

Worked example — Petra Osei

Week 1. Treated same day; lift assist quarantined and photographed; maintenance file pulled, showing two malfunction reports in the prior month with no repair order. Video preserved. First Report filed on day two. Witness statements taken.

Week 2. Recorded statement. She reports the March lifting event and four years of overhead work. Carrier accepts the specific injury and reserves on the cumulative trauma theory. AWW computed at $1,040 — but her second job at a restaurant, which the state includes, raises it to $1,290. Benefit rate rises by $167 per week.

Week 3. Third-party screen produces two defendants: the lift assist manufacturer and the maintenance contractor. Counsel retained; equipment preserved under a joint inspection protocol.

Month 2. Restrictions issued: no overhead lifting, 15-pound limit. Northgate offers a genuine modified position in returns processing, in writing. Petra accepts. ADA interactive process documented. FMLA designated concurrently.

Month 7. MMI declared after arthroscopic repair. Treating physician rates 9% upper extremity impairment; employer's examiner rates 4%. Agreed medical examiner splits at 7%. Apportionment to a documented 2019 shoulder complaint is litigated.

Month 10. Third-party case settles. Carrier's lien is $118,000, reduced by a pro rata share of fees and costs to $74,000, with a future credit against the remaining benefit exposure that is worth more than the lien reduction.

Month 14. Comp settlement with an MSA. CMS review threshold met; allocation submitted and approved after four months. Structure funds the MSA over the claimant's life expectancy at lower present cost.

What went right. The equipment was preserved in week one, the second job was caught in the AWW, and the light duty offer was genuine. Those three decisions changed the file's value more than anything that happened afterward.

Handling a Workplace Injury and Workers' Compensation Claim: A Practical Checklist

Phase 1 — The first hour

Phase 2 — Notice and reporting

Phase 3 — Preserve, and screen for the third-party case

Phase 4 — Investigate compensability

Phase 5 — Accept or deny

Phase 6 — Compute average weekly wage correctly

Phase 7 — Manage medical care

Phase 8 — Pay indemnity benefits

Phase 9 — Return to work

Phase 10 — The parallel ADA and FMLA obligations

Phase 11 — MMI and impairment

Phase 12 — The third-party action and the lien

Phase 13 — Settlement and Medicare

Phase 14 — Dispute and hearing

Phase 15 — Do not retaliate

Phase 16 — OSHA recordkeeping

Phase 17 — Program management

Phase 18 — The claimant-side sequence

Worked example — Petra Osei

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