Forms

Question 1

What are the 7 uses of the 827 Form

Answer 1

First report of injury or disease (sent within 72 hours of office visit)

Request to accept new or omitted medical condition

Report of Aggravation (Agg)

Change of Attending Physician (AP) (Sent within 5 days of office visit)

Progress report

Closing report

Palliative care request

Question 2

Which forms are used to first report injury or disease

Answer 2

801, 827, (1502 in conjunction with 801 or 827)

Question 3

Timeframe for the 801 form to be submitted

Answer 3

5 days from Employer Date of Knowledge (EDOK)

Question 4

Reasons for the 1502 used by insurer (14 days to submit)

Answer 4

First report of claim decision to WCD (disabling acceptance and all denials)

All denials

New or Omitted conditions reopening

aggravation decision

reopening for vocational training (VOC training)

litigation order acceptance

change in status (acceptance or disability

correction of previous information

MCO enrollment after a previous report

Question 5

Use of 1503

Answer 5

Notice of claim closure (14 days to submit by insurer to WCD)

Question 6

Use of 1644

Answer 6

Notice of claim closure to injured worker (IW) send within 14 days of decision to close claim.