Claims Notification Process
Workers' Compensation Report of Job Injury or Illness
Submit a Workers’ Compensation claim using the online 801 form. By completing the 801 form, workers are filing a legal claim for Workers’ Compensation Benefits. Completion of this form should occur when the work accident/injury requires medical treatment or causes the worker to miss time from work.
Workers should complete an Accident/Incident Report Form within 24 hours of any work injury or accident. Supervisors should complete their section of this form within 24 hours of receiving notice or knowledge of the work incident. Submit the completed form to firstname.lastname@example.org
or fax to 503-763-3901.
NOTE: If a worker has a previously accepted Workers’ Compensation Claim and they would like to file an aggravation, they will need to contact their attending physician (MD, DO or Oral Surgeon) and complete form 827 for Notice of Claim for Aggravation. A new 801 form should not be completed for claim reopening.
Property & Liability Claim Reporting Form
Submit a General Liability Claim, Automobile Crash Report, or Property Damage Claim.
Emergency Claim Notification Process
Please utilize the following procedures when reporting serious incidents* or fatalities.
* Serious incidents would include accidents involving injuries requiring admittance to a hospital, police incidents involving use of firearms, public allegations of sexual misconduct involving public officials, or other "high profile" incidents involving potential civil liability.
- Contact local emergency response personnel to handle immediate threats to life or property.
- Secure the scene.
- Follow your Emergency Policy/Procedure for internal response, reporting notification.
- Notify CIS Claims at 1-800-922-2684 and ask to be directed to Jim McWilliams (Claims Manager). If you are calling after hours and this is a true emergency, call the emergency claims number, 503-763-3897, and your call will be forwarded to the on-call claims examiner.
- Contact your Employee Assistance Program (EAP) for counseling and critical incident debriefing as needed.
- Conduct an internal investigation, document facts and submit the appropriate claim form to CIS Claims. Workers’ Compensation claim forms are available online.
- If news media are requesting comment, be sure to follow your entity’s policy regarding media contact and public information. If you need assistance in developing such a policy, please contact CIS. Please note to call OR-OSHA at 1-800-922-2689 if a fatality or serious disabling injury requiring hospitalization has occurred. Fatalities must be reported within 8 hours and in-patient hospitalization of an employee within 24 hours.
An incident report may be used if the injured worker is not planning to seek medical treatment. The 801 Claim Form must be completed when medical treatment or time off work occurs and should be forwarded to CIS Claims within five working days at the following address:
PO Box 1469
Lake Oswego, OR 97035
After hours or on weekends, leave a voice message with CIS for a return call during business hours.