Filing a Workers' Compensation Claim

Employee Forms:

Employee's Report of Injury (SORM-29) [English] [Spanish] – The employee must complete this form immediately after sustaining a work-related injury. The form should be submitted to the Claims Coordinator who forward a copy to the State Office of Risk Management (SORM)

Authorization for Release of Information (SORM-16) [English] [Spanish] - The employee must complete this form immediately after sustaining a work-related injury and submit to the Claims Coordinator who will forward a copy to SORM.

Employee Election Form (SORM-80) [English] [Spanish] - employee must complete this form immediately after sustaining a work-related injury and submit to the Claims Coordinator who will forward a copy to SORM.

Workers Compensation Network Acknowledgement Form:  [English] [Spanish] - The employee must complete this form immediately after sustaining a work-related injury. The form should be submitted to the Claims Coordinator who will forward a copy to the State Office of Risk Management (SORM).

Employee Network Notification Packet: [English] [Spanish] - The employee network notification packet provides employees with information on how to get health care under workers’ compensation insurance. Please read the packet before signing the Workers’ Compensation Network Acknowledgement form which can be found directly above or in the employee notification packet. Additional information along with a brief video for employees can be found on SORM’s CompKey+ Employee page.


Supervisor Forms:

Supervisor’s First Report of Injury or Illness [English] – This form shall be completed by the injured employee’s supervisor or their designated representative and submitted to the Claims Coordinator within 24 hours in order to meet state stipulated deadlines. Failure to submit the necessary forms on a timely basis may delay medical and income benefits to the injured employee and may result in administrative fines to the University.

Witness Statement (SORM-74) [English] [Spanish] - The form must be completed by each witness to the accident. The injured employee's supervisor or designee should forwarded the statements to the Claims Coordinator.