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State Marylandleft000?Read and follow all instructions before?accessing our WebForms.You must install Formatta(c)?Filler?free software to use our Online Forms.? Formatta Filler is available only for Windows. Click here to download and install Formatta Filler.? Select "RUN" when prompted to download the "fillersetup.exe" and follow the on screen installation instructions.? If using a business/corporate PC, you MUST have access/rights to install software for Filler to function.? If you do not have permissions to install software on your PC, please "Save" instead of "Run" and contact your IT support to install this software.After a successful installation Filler will launch?with a success image and Formatta will appear in your "Programs" list.Employer's First Report of Injury (FROI) IAIABC?1A-1 (WCC # SF-1) filed by the employer or their workers' compensation insurance carrier.? The injured worker will file the Employee Claim Form C-1.Required form: Code of Maryland, Labor and Employment §9–707 Open the online MDWCC Employer's First Report of Injury FormA First Report of Injury (FROI) must be filed by the employer/insurer with the Workers’ Compensation Commission.? In accordance with COMAR 14.09.01.02 – Commission Forms, the Commission only accepts the FROI form prepared by and issued by the Commission, form IA-1 (r 1-1-02).The fields Type of Injury/Illness, Date of Death (if applicable) and Initial Treatment must be completed and are required by Maryland Occupational Safety and Health (MOSH), a unit of the Division of Labor & Industry. If these and all other required fields are not complete or on a form other than the Commission’s, the FROI will be returned. Please see the complete list of acceptable WCIO Type of Injury/Illness codes link below.? These fields are provided on our online FROI.Instructions & InformationInstructions for completing the Employer's First Report of Injury form (effective 7/01/14)Type of Injury/Illness Codes (included on online form) to complete hardcopy forms.There is no PDF or downloadable offline version of this form.? To request a hardcopy please use this link.? You must provide a shipping/mailing address in your request.Technical questions about the online form? Email us - websupport@wcc.state.md.plete the online form and electronically submit it to the Workers' Compensation Commission by?selecting the Submit button on the electronic form.Print and save the completed form after submission as prompted.? A copy should be sent?to the employer's?workers' compensation insurance carrier.? A valid email address is required to submit the form.? A receipt of form success or failure is sent to the address entered on the form.? All general information pertinent WCC WebForms on this page or other instructions included with specific forms are applicable. ................
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