Alaska Statute 23.30.155 (m) requires that each insurer providing workers' compensation coverage in Alaska, or their adjuster, file a report annually with the Alaska Workers' Compensation Board. Employee Report to Employer - Form 07-6100 (word) Employer Report to Division of Workers' Compensation - Form 07-6101 (word) Example - Form 07-6101 (pdf) Third-Party Claims Administrator: Penser North America Inc. PO Box 241148. Information about Alaska Assigned Risk Pool as well as the ability to report a claim and view loss reports. Coverage. Search. Compensation & Travel Report of Executive Positions Calendar Year 2019. Section 11. To get the help you need to ensure employees understand coverage’s and how to report a work place injury, select the link located below. Just go to the APEI website and select the Employee or Employer workers compensation reporting form here: /claims/#comp, Once submitted, the report will automatically be sent to our claims team, who will then send the employee a medical release form that needs to be signed, and follow up with any questions. Section 12. Workers' compensation state claims reporting forms. Construction Risk Workers' Compensation: 800-910-2667; Excess Workers' Compensation: 866-473-0756; Primary Workers' Compensation: 877-399-6442; Workers' Compensation First Notice of Loss Questions Learn what questions to expect when reporting an injury. Government Contract Services; You must report your injury in writing to your employer within 30 days of your injury. Section 10. Claims reporting includes the first reports of injury (FROI) and subsequent reports of injury (SROI), commonly referred to as compensation reports. 20-05, COVID-19 Presumption of Compensability for Emergency Response and Health Care Employees (PDF); Bulletin No. 800-553-8041 Workers’ Compensation – Notice Only First responders and health care workers who test positive for coronavirus are receiving a presumption of work-related occupational disease in some states giving them access to wage replacement benefits and death benefits. Workers’ Compensation Payroll Reporting Alaska All employees covered by the policy are reported at their actual wage, as defined in the above information, but at no time less than the state minimum wage. Workers' Compensation Appeals Commission. Public Employees: Public employers may not discriminate against public employees (or their representatives) for reporting to a public body and matter of public concern. Cover Letter [PDF] ... State of Alaska Department Administration Division of Finance. Box 32036, Lakeland, FL 33802-2036. Report Date Workers' Compensation Appeals Commission. Workers’ compensation insurance can seem complicated to administer. Section 9. All Workers Compensation Claim reporting is submitted via Electronic Data Interchange (EDI) transactions through approved, registered EDI Senders or by paper submissions to Alaska … Powers and Duties of the Chair of the Commission. Alaska provides compensation for medical treatment, lost wages from time away from work, compensation for permanent impairment resulting from a work injury, training for a new position, and death benefits including burial expenses. Extraterritorial Coverage. A multi-line commercial insurer. Alaska Statute 23.30.155(m) requires that each insurer or adjuster file a report providing all compensation activity for the previous year annually with the Alaska Workers’ Compensation Board. Agreements in Regard to Claims. You must give written notice to your employer and the Workers` Compensation Board within 30 days after the accident or when you think you have an illness caused by work. Workers' Compensation Bulletins 2020. In cases involving fatalities, dependents may be eligible for death benefits. Physical Address: State Office Building, 333 Willoughby Avenue, 10th Floor, Juneau, AK 99801 Mailing Address: PO Box 110204, Alaska Workers' Compensation Act Section 155. Please review the following guide which may be posted at the worksite. Public Employees: Public employers may not discriminate against public employees (or their representatives) for reporting to a public body and matter of public concern. Filing workers' compensation claims; Filing safety complaints; Testifying as a witness in a legal proceeding; Statutory Protections. State of Alaska Department Administration Division of Finance. For additional information, see the, The Department of Labor and Workforce Development and the Alaska Workers’ Compensation Board give notice that amended versions of material adopted by reference in 8 AAC 45.083, dealing with fees for medical treatment and services, are in effect. Email the Webmaster, Alaska Department of Labor and Workforce Development, Sign up to receive 'What's New' email updates, Workers' Compensation Benefits Guaranty Fund, Online Public Notice of Amended Material Previously Adopted by Reference, 2021, Amended Material Previously Adopted by Reference, 2020 ICD, Public Notice of Amended Material Previously Adopted by Reference, Effective Jan. 1, 2021, Public Notice of Amended Material Previously Adopted by Reference ICD, Oct. 1, 2020, Department of Labor and Workforce Development, To request an ADA accommodation with the Division of Workers’ Compensation, please email, The Alaska Workers' Compensation Board will conduct a full board meeting on January 14-15, 2021. Start Date. § 39.90.100. Employee's Name (Last, First, Middle Initial) 43. The report is due on or before March 1st. 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