Workers' Compensation Forms and Information

First Report of Injury Instructions

When an employee notifies their supervisor that an injury has occurred, it is the department’s responsibility to obtain all pertinent information needed for completion of the first report of injury. The department will need to complete the First Report of Injury or Illness (FROI), provided in the files tab of this article, with all of the pertinent information immediately, but no later than 24 hours after the injury occurs. All questions relating to the accident must have detailed answers. The completed FROI will need to be email to msu.hr@murraystate.edu without a social security number listed, within 24 hours.

Please review KEMI's Provider Search Tool to identify an in-network provider, if the employee will be seeking further medical treatment. Local providers in Murray, KY include Murray Medical Associates, Fast Pace Kentucky and Baptist Health Medical Group Primary Care. For emergencies only, please visit the local emergency room (Murray-Calloway County Hospital).

If an injury requires further medical treatment the department will need to give the injured employee the Workers Compensation Injury Kit (PDF), provided in the files tab of this article, and the following required forms will need to be completed:

• Notice of Designated Physician (Scan or fax to 3464 HR with employee/student worker signature)

• Medical Waiver and Consent Form (Scan or fax to 3464 HR with employee/student worker signature)

If the injury occurs during the second or third shift or on the weekend, the injury must be reported at the beginning of the next working day. A delay in reporting an injury has the potential for denial of coverage. It is very important that the above information and other related information (medical bills, disability statements, doctors’ reports, etc.) be submitted quickly to avoid denial of workers’ compensation benefits.

We appreciate your assistance in helping us process workers’ compensation claims. If you have any questions concerning these procedures or forms, please call Human Resources at 2146.