EMPLOYERS FIRST REPORT OF ACCIDENT (EFR)
You may report a Workers' Compensation claim two ways:
On-line at ClaimZone Reporter. The supervisor is able to complete the first report via the web-site. User ID and password required for access. Click to access ClaimZone Reporter.
Download the ClaimZone Reporter User's Guide for more information.
Download Location Code handbook.
By phone 24/7 at 888 606-2562. The phone will be automatically answered "Montgomery County Self-Insurance Program, first report of injury". A telephonic first report representative will receive your call and prompt you through the questions necessary to complete the report. The representative will complete the FROI, electronically forward a copy to the MCSIP claim office and return a copy to the reporting individual, if requested.
Click to download How To Report Employee Work-Related Injuries/Illness. The "How To" document is a tool to assist you in organizing information prior to making your call. The following items are a few of the key questions asked:
- Agency name, address and location code (if known) - Download Location Code handbook
- - Injured employee's full name, date of birth, and social security #
- - Date the accident occurred
- - Location of the accident and any witnesses
- - Your description of the accident, please start with "Employee states" (remember, this is the employer's report of the accident)
- - Name and address of all medical providers
- - Date of Hire
- - Is the injured employee a member of a Union, if so, which one
- - Is the Injured Employee opting to treat with a Network Physician and within the Manage Care Program
Questions? Call MCI at (703) 817-0407.
Employee Instructions
Following is a link to instructions for workers' compensation claims.
Download employee instructions for Workers' Compensation Claims
If you need a supply of preprinted cards, please click here and advise how many and the correct name and address to send the cards.