Critical Notice - Workers' Compensation Claims

When an employee has a work-related injury, the Bureau of Workers’ Compensation requires that an Employer’s First Report of Work Injury or Illness (Form C-20) be completed. The Form C-20 initiates a workers’ compensation claim and is a required filing with the Bureau of Workers’ Compensation, so the filing needs to be accurate and thorough. If possible, it is encouraged to have the employee also sign the Form to ensure the information provided is accurate. Under the Workers’ Compensation Law and associated Rules and Regulations, as the employer, you are required to submit this information to Public Entity Partners, your insurance carrier, within one (1) day of the reporting of a work-related injury.

We encourage you to submit this information through our online claims portal.  This is the fastest way to send the information to an adjuster, which allows us to respond and assist your injured employee sooner.  It also ensures that the information required by the Bureau of Workers' Compensation about the employee and the injury is reported to them quickly and accurately.

In order to submit a workers’ compensation claim, you will need a general description of how, when, and where the injury occurred; what injury the employee sustained; when the injury was reported to you; whether medical treatment was necessary; and where the employee was initially treated. 

The claim also requires the following information:

• • • Social Security Number
    • Date of Hire
    • Employee’s Address
    • Employee’s Date of Birth
    • Employee’s Rate of Pay
    • Employee’s Occupation
    • Department in which Employee Worked

Additional information is also required in order to fully complete the Form C-20, so please review this sample C-20. Every box on the Form C-20 must be completed, to the best of your knowledge, at the time of submission in order for Public Entity Partners to properly file the claim with the Bureau of Workers’ Compensation. If you have questions or concerns about filing a workers’ compensation claim, we encourage you to reach out to our workers’ compensation claims team.