Your employer must fill out and sign the “employer” portion of the form and give the completed
form to a claims administrator.

This person handles workers’ compensation claims for your

(Most claims administrators work for insurance companies or other organizations that
handle claims for employers. Some claims administrators work directly for large employers that
handle their own claims. This person may also be called a claims examiner or claims adjuster.)
Your employer must give or mail you a copy of the completed form within one working day after you filed it. Keep this copy.

The claims administrator must decide within a reasonable time whether to accept or deny your