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Understanding the First Report of Occupational Injury or Illness (NWCC Form 1)

July 2, 2025
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Understanding the First Report of Occupational Injury or Illness (NWCC Form 1)

Workplace injuries, while unfortunate, must be managed with precision and regulatory compliance. One of the most critical tools in this process is the First Report of Alleged Occupational Injury or Illness, commonly referred to as the First Report of Injury (FROI). In Nebraska, this is formalized through NWCC Form 1 (Revised 03-02), issued by the Nebraska Workers’ Compensation Court (NWCC).

This article explains the purpose, structure, and proper use of the form, providing insight into how it supports both legal compliance and effective claims management.

Purpose of the First Report Form

The NWCC Form 1 is more than just paperwork—it initiates and documents the legal and administrative process following a work-related injury or illness. Specifically, it serves to:

  • Satisfy Nebraska workers' compensation reporting requirements
  • Initiate the claims process for employee benefits
  • Assist in OSHA compliance and injury tracking
  • Facilitate coordination between employers, insurance carriers, and third-party administrators (TPAs)

Timely and accurate completion of this form is mandatory to ensure smooth claims processing and avoid legal or financial penalties.

Core Sections and Their Functions

1. Employer and Insurance Information

This section collects details about the employer and their workers' compensation coverage. Key fields include:

  • Employer FEIN and SIC Code: Used to identify and classify the employer.
  • Report Purpose Code: Indicates if the form is an original, correction, or other type of report.
  • Insurance Carrier Information: Includes the carrier's name, FEIN, contact details, policy number, and coverage period.
  • Claim Administrator: Identifies the party managing the claim, which may differ from the insurer (e.g., a TPA or risk pool).

2. Employee Information

Accurate employee data is critical for proper benefit calculation and claim identification:

  • Personal Information: Name, address, phone number, date of birth, Social Security number, and hire date.
  • Job and Compensation Details: Job title, employment status (full-time, part-time), scheduled workdays per week, and wage structure (hourly, weekly, etc.).
  • Dependent and Marital Status: Used to help determine certain benefit calculations.

3. Incident Details

The heart of the report lies in this section, which captures:

  • Date and Time of Injury: When the employee began work and when the injury occurred.
  • Location of Incident: Including whether it occurred on the employer's premises.
  • Injury Description:
    • Type of Injury/Illness (e.g., "sprained ankle")
    • Part of Body Affected (e.g., "left ankle")
    • Cause and Mechanism: Narrative describing how the injury occurred, including any equipment or activity involved.
    • Standardized Codes: Nature, body part, and cause of injury codes for data consistency.

4. Medical Treatment and Reporting

This section outlines how the injury was treated and includes:

  • Initial Treatment Level: Options range from no medical treatment to emergency care or hospitalization over 24 hours.
  • Healthcare Provider Info: The name of the treating provider or facility.
  • Disability and Return to Work Dates: When applicable, includes date of disability onset and date the employee returned to work.
  • Fatal Injuries: If applicable, the date of death must be recorded.

5. Administrative Details

The form concludes with metadata such as:

  • Date Employer Notified
  • Date Claim Administrator Notified
  • Form Preparer’s Name, Title, Phone Number
  • Date Prepared

Instructions and Coding Reference

The second page of NWCC Form 1 provides detailed instructions and definitions for every field on the form. This includes:

  • Mandatory Fields: Marked in bold—if missing, the form will be rejected.
  • Code Definitions: For occupational codes, injury type, and report purpose.
  • Clarification on jurisdiction claims, OSHA case numbers, and policy details.

This structured guidance ensures consistency across all employers and claims administrators when reporting injuries.

Compliance Tips and Best Practices

  • Complete All Mandatory Fields: To avoid rejection or delay.
  • Submit Promptly: File immediately after the incident or as soon as the employer becomes aware of it.
  • Use Standard Codes: These aid in regulatory reporting and internal analytics.
  • Keep Copies: Retain for employer records and share with insurers and administrators.
  • Review for Accuracy: Errors in time, dates, or treatment levels can complicate claims.

Conclusion

The First Report of Injury (NWCC Form 1) is a cornerstone of compliant occupational health and safety administration. Employers and administrators should treat its completion with care and urgency. Proper use of this form protects employees' rights, limits employer liability, and ensures streamlined coordination with insurers and regulatory bodies.

If your organization needs a PDF copy or help completing, call 402-502-1819 or email eric@integratedcarellc.com.

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