Disclaimer: We thought that providing step by step instructions on how to file the Workers' Comp application would help with the application process. We compiled this step by step process based on our personal experiences but our advise should not replace Workers' Comp or Dept. of Administration instructions.
Here's what you need to do when you're having health problems related to the Juneau Labor building:
Who should I report the problem to?
You need to let your supervisor know that you're having health issues related to the building and file an Occupational Injury and Illness to Workers' Compensation within 30 days of knowledge of a work related injury. Write down the names of the people who saw your accident or the work conditions that may have caused your illness.
What forms do I need to fill out?
1) Report of Occupation Injury and Illness Form or Form 07-6101. Click here to download the form.
2) Leave slip - to document time lost.
Now that I have the forms, what do I need to do next?
1) You will need to completely fill out the top portion of Form 07-6101 that says "Employee". Under section #14, document every symptom you have related to the exposure. Once your portion is complete, forward this form to your supervisor and have him or her complete the bottom section that says "Employer". Remember to get this form back from your supervisor.
2) Fill out the leave slip and indicate the date and time you left work due to an illness.
Note: Workers' Compensation will not compensate you for the first 3 days due to a 3-day waiting period. After you serve the waiting period, they will begin compensating you for time lost. You need to document time lost with doctor's statement and provide this statement as proof to Workers' Compensation in order for them to reimburse you.
3) Scan and email the completed Form 07-6101 and Leave Slip to [email protected] and to [email protected] or take your papers directly to the Workers' Comp office on the third floor and document the name of the person with whom you filed the papers. Remember they don't forward these papers to the Department of Administration so you still need to scan and email a copy of both forms to [email protected].
What should I expect next?
From Worker's Compensation: Within a few days after submitting your paperwork to WC, you should get a letter from them confirming that your application has been established. This letter also contains the following information: 1) AWCB Number or claim number which you will need to refer to in all correspondence with WC, 2) Insurer (Harbor Adjustment Service Inc located in Anchorage, AK), 3) General Information regarding workers' comp benefits.
If you didn't receive a letter from WC please follow-up with them.
From the Dept. of Administration: You should receive an email confirmation that your paperwork was received and the name of the person assigned to your case.
HELPFUL HINTS: Keep your own copies of emails, leave slips, medical information and any paperwork you fill out and submit. This can help you later in the process. Also keep a log of when you miss a day of work or feel poorly in the building and what is going on at that time with the building. Was there construction, were they working on the HVAC system, were others also sick, what were the symptoms, were the symptoms worse inside the building?
We highly encouraged you to file for a WC claim.
Filing a WC claim is very important, this is our way to have administration hear our voices. Please don't get discouraged, remember WC represents the employer it's in their best interest to deny our claim.
Here's what you need to do when you're having health problems related to the Juneau Labor building:
Who should I report the problem to?
You need to let your supervisor know that you're having health issues related to the building and file an Occupational Injury and Illness to Workers' Compensation within 30 days of knowledge of a work related injury. Write down the names of the people who saw your accident or the work conditions that may have caused your illness.
What forms do I need to fill out?
1) Report of Occupation Injury and Illness Form or Form 07-6101. Click here to download the form.
2) Leave slip - to document time lost.
Now that I have the forms, what do I need to do next?
1) You will need to completely fill out the top portion of Form 07-6101 that says "Employee". Under section #14, document every symptom you have related to the exposure. Once your portion is complete, forward this form to your supervisor and have him or her complete the bottom section that says "Employer". Remember to get this form back from your supervisor.
2) Fill out the leave slip and indicate the date and time you left work due to an illness.
Note: Workers' Compensation will not compensate you for the first 3 days due to a 3-day waiting period. After you serve the waiting period, they will begin compensating you for time lost. You need to document time lost with doctor's statement and provide this statement as proof to Workers' Compensation in order for them to reimburse you.
3) Scan and email the completed Form 07-6101 and Leave Slip to [email protected] and to [email protected] or take your papers directly to the Workers' Comp office on the third floor and document the name of the person with whom you filed the papers. Remember they don't forward these papers to the Department of Administration so you still need to scan and email a copy of both forms to [email protected].
What should I expect next?
From Worker's Compensation: Within a few days after submitting your paperwork to WC, you should get a letter from them confirming that your application has been established. This letter also contains the following information: 1) AWCB Number or claim number which you will need to refer to in all correspondence with WC, 2) Insurer (Harbor Adjustment Service Inc located in Anchorage, AK), 3) General Information regarding workers' comp benefits.
If you didn't receive a letter from WC please follow-up with them.
From the Dept. of Administration: You should receive an email confirmation that your paperwork was received and the name of the person assigned to your case.
HELPFUL HINTS: Keep your own copies of emails, leave slips, medical information and any paperwork you fill out and submit. This can help you later in the process. Also keep a log of when you miss a day of work or feel poorly in the building and what is going on at that time with the building. Was there construction, were they working on the HVAC system, were others also sick, what were the symptoms, were the symptoms worse inside the building?
We highly encouraged you to file for a WC claim.
Filing a WC claim is very important, this is our way to have administration hear our voices. Please don't get discouraged, remember WC represents the employer it's in their best interest to deny our claim.
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