Employer's Accident Report Instructions

Notes before filing a report

Form behaviors:

• Use the "Tab" key to move through the form.
• Drop down selection fields may be navigated by typing the first letter of the item being searched for. The first item in the list starting with that letter will be displayed. It will not recognize additional typed characters. To navigate a long list, switch to navigating with the mouse or arrow keys.
• Time fields will recognize as 12 or 24 hour time. If a colon ":" is used, AM or PM designation is required.

Required fields:

Orange fields and fields with an asterisk (*) are required for submitting a form. They are critical elements needed to properly set up and process the claim. Please also fill in non-required fields if possible; however, if you do not have non-required information when first reporting, the Workers’ Compensation team can add it later. 

Email notification address fields: 

Virginia Tech's Workers’ Compensation team in the Division of Human Resources will automatically receive submission confirmation emails when a report is filed. The addresses  for this team are visible at the top of the form once the agency is selected under Employer Information. There will be a space where additional email addresses may be added to receive report submission emails. For example, the initial submission email and second submission notice with form and claim number can be sent to an injured worker. It is optional to add additional notification emails. 

Filing an accident report

Where to file:

• Go to froi.sedgwick.com.
• Select "Continue without Logging in" to go past the log in screen.

Employer section:

• Under the Employer area, select "208 - VPI State University".
• Under Sub-Agency/Department, select the appropriate college or Senior Management Area and department from the lists.
• If you have an internal Employer Case Number for the accident, add it here.
• If the incident occurred at a location different from the official employer's address, enter it here.

Note: If you receive an error message when you try to submit that says, "Cannot submit. Please select an Agency before submitting for review," you must select an agency for the form to be directed to an HR reviewer.

Employee section:

• Complete the personal information for the injured party in this section. 
• Include the Virginia Tech 90-number in the Employee ID field.
• "NCCI occupation classified" will auto-populate based on the "Occupation at time of injury or illness" field.

Time and place of accident section:

• Provide detail surrounding the time and place of the accident and injury reporting.
• Claim types:
  • Record only: No time lost, no physician/hospital care needed
  • Medical only: Physician/hospital care needed; no time lost or less than seven (7) days expected
  • Indemnity: More than seven (7) days of lost time expected

Nature and cause of accident section:

• In this section, describe in the best detail possible the accident being reported.
• Drop-down options may not include an exact match for the particular incident; use your best judgement.
• If employee sought medical treatment, include physician and/or facility details.
• “Comments to carrier claim staff” is a section to provide any further information that does not fit elsewhere.
• Initial Treatment choices description:
  • 00 - No medical treatment at all
  • 01 - Minor First Aid on site
  • 02 - Urgent Care facility / clinic other than ER/physician
  • 03 - Emergency Room
  • 04 - Admitted to Hospital
  • 05 - Expecting future significant medical care and lost time

Preparer Information:

This should be the information for who is completing the form. Please include at least one method of contact.

Submitting the Employer's Accident Report:

• Select the "Submit" button. A small pop up window will display "Submitted for Review". Select "OK" to acknowledge.
• When the report is submitted, it will be transferred to the Virginia Tech Division of Human Resources Workers' Compensation team for further processing.
• PDF copies of the form can be downloaded via the link at the bottom of the page.