When you are injured it is the responsibility of the employer to report an alleged injury, whether or not the employer agrees with the claim or not. The employer is responsible for completing this form. If the employer is unable or refuses to file this form, the DOLI may request that the insurer prepares one.
When is this form completed?
- within 10 days of the first day of disability or the date they were aware of the disability;
- within 48 hours of a death or serious injury.
When is it to be filed with DOLI?
This form must be filed with the Minnesota Department of Labor and Industry by the insurer if the claim results in the employee’s inability to work for a period of more than three days (or results in permanent partial disability):
- within 14 days of the first day of disability or the date the employer was aware of the disability, whichever is later;
- within 10 days of a request from the department, to complete a substitute filing of this form if the employer is unable or refuses to file this form.
Where is this form sent?
The employer must send this form to:
- the workers’ compensation insurance company;
- the employer;
- the employee.
If you are injured, make sure you get a copy of the FROI to confirm the information is accurate. If the employer or insurer fail to provide you with a copy, notify the Minnesota Department of Labor and Industry and request a copy from them.
