Free WC Alabama First Report of Injury Codes - Alabama

NATURE OF INJURY 01. No Physical Injury 02. Amputation 03. Angina Pectoris 04. Burn 07. Concussion 10. Contusion 13. Crushing 16. Dislocation 19. Electric Shock 22. Enucleation 25. Foreign Body 28. Fracture 30. Freezing 31. Hearing Loss or Impairment 32. Heat Prostration 34. Hernia 36. Infection 37. Inflammation 40. Laceration 41. Myocardial Infarction 42. Poisoning - General 43. Puncture 46. Rupture 47. Severance 49. Sprain or Tear 52. Strain or Tear 53. Syncope 54. Asphyxiation 55. Vascular 58. Vision Loss 59. All Other Specific Injuries, NOC 60. Dust Disease, NOC 61. Asbestosis 62. Black Lung 63. Byssinosis 64. Silicosis 65. Respiratory Disorders 66. Poisoning - Chemical, (Other Than Metals) 67. Poisoning - Metal 68. Dermatitis 69. Mental Disorder 70. Radiation 71. All Other Occupational Disease Injury, NOC 72. Loss of Hearing 73. Contagious Disease 74. Cancer 75. AIDS 76. VDT - Related Diseases 77. Mental Stress 78. Carpal Tunnel Syndrome 79. Hepatitis C 80. All Other Cumulative Injury, NOC 90. Multiple Physical Injuries Only 91. Multiple Injuries Including Both Physical & Psychological

PART OF BODY 10. Multiple Head Injury 11. Skull 12. Brain 13. Ear(s) 14. Eye(s) 15. Nose 16. Teeth 17. Mouth 18. Soft Tissue 19. Facial Bones 20. Multiple Neck Injury 21. Vertebrae 22. Disc 23. Spinal Cord 24. Larynx 25. Soft Tissue 26. Trachea 30. Multiple Upper Extremities 31. Upper Arm 32. Elbow 33. Lower Arm 34. Wrist 35. Hand 36. Finger(s) 38. Shoulder(s) 39. Wrist (s) & Hand(s) 40. Multiple Trunk 41. Upper Back Area 42. Lower Back Area 43. Disc 44. Chest 45. Sacrum and Coccyx 46. Pelvis 47. Spinal Cord 48. Internal Organs 49. Heart 50. Multiple Lower Extremities 51. Hip 52. Upper Leg 53. Knee 54. Lower Leg 55. Ankle 56. Foot 57. Toes 58. Big Toes 60. Lungs 61. Abdomen Including Groin 62. Buttocks 63. Lumbar & or Sacral Vertebrae 64. Artificial Appliance 65. Insufficient Info to Properly Identify 66. No Physical Injury 90. Multiple Body Parts 91. Body Systems and Multiple Body 99. Whole Body

INSTRUCTIONS FOR FILING WC FIRST REPORT OF INJURY
Employers should send a completed legible form to the insurance carrier or, if self-insured, to the designated office handling their workers' compensation claims. The insurance carrier or designated office should forward this First Report on to the Workers' Compensation Division, Department of Industrial Relations, Montgomery, Alabama 36131 within fifteen (15) days from the date of injury or date of notification to the employer for all injuries for which compensation is claimed or paid. This includes deaths, permanent disabilities or temporary disabilities exceeding three (3) days). Block 1. A number assigned by the insured to identify a specific claim Block 2. An identifier for a specific claim within a claim administrator's claims processing system. Block 3. Case number from log maintained for OSHA Block 4 - Block 14. Self Explanatory Block 15. Employer Federal ID number Block 16. Employer Unemployment Compensation Account Number Block 17. NAICS Industry Codes http://dir.alabama.gov/docs/forms/wc_naics.pdf Block 18. Carrier's name Block 19. Carrier's FEIN Block 20. A code representing the kind of entity providing financial responsibility for the claim, exp: ( I ) Insurance Carrier (S) Self Insurer (G) Guarantee Fund/Group Block 21 through Block 63. Self Explanatory Block 64. Nature of Injury Codes http://dir.alabama.gov/docs/forms/wcio_nature_table.pdf Block 65. Part of Body Codes http://dir.alabama.gov/docs/forms/wcio_part_table.pdf Block 66. Cause of Injury Codes http://dir.alabama.gov/docs/forms/wcio_cause_table.pdf Block 67 through Block 81. Self Explanatory

CAUSE OF INJURY 01. Chemicals 02. Hot Objects or Substances 03. Temperature Extremes 04. Fire or Flame 05. Steam or Hot Fluids 06. Dust, Gases, Fumes or Vapors 07. Welding Operation 08. Radiation 09. Contact With, NOC. 10. Machine or Machinery 11. Cold Objects or Substances 12. Object Handled 13. Caught In, Under or Between, NOC. 14. Abnormal Air Pressure 15. Broken Glass 16. Hand Tool, Utensil; Not Powered 17. Object Being Lifted or Handled 18. Powered Hand Tool, Appliance 19. Caught, Puncture, Scrape, NOC. 20. Collapsing Materials (Slides of Earth) Either Man Made or Natural 25. From Different Level (Elevation) Off Wall, Catwalk, Bridge, Etc. 26. From Ladder or Scaffolding 27. From Liquid or Grease Spills 28. Into Openings Shafts, Excavations, Floor Openings, Etc. 29. On Same Level 30. Slipped, Do Not Fall 31. Fall, Slip or Trip, NOC. 32. On Ice or Snow 33. On Stairs 40. Crash of Water Vehicle 41. Crash of Rail Vehicle 45. Collision or Sideswipe With Another Vehicle 46. Collision with a Fixed Object Standing Vehicle or Stationary Object 47. Crash of Airplane 48. Vehicle Upset Overturned or Jackknifed 50. Motor Vehicle, NOC. 52. Continual Noise 53. Twisting 54. Jumping 55. Holding or Carrying 56. Lifting 57. Pushing or Pulling 58. Reaching 59. Using Tool or Machinery 60. Strain or Injury By, NOC. 61. Wielding or Throwing 65. Moving Part of Machine 66. Object Being Lifted or Handled 67. Sanding, Scraping, Cleaning Operation 68. Stationary Object 69. Stepping on Sharp Object 70. Striking Against or Stepping On, NOC. 74. Fellow Worker; Patient 75. Falling or Flying Object 76. Hand Tool or Machine in Use 77. Motor Vehicle 78. Moving Parts of Machine 79. Object Being Lifted or Handled 80. Object Handled By Others 81. Struck or Injured, NOC. 82. Absorption, Ingestion or Inhalation, NOC 84. Electrical Current 85. Animal or Insect 86. Explosion or Flare Back 87. Foreign Matter (Body) in Eye(s) 88. Natural Disasters 89. Person in Act of a Crime 90. Other Than Physical Cause of Injury 91. Mold 94. Repetitive Motion Callous, Blister, Etc. 95. Rubbed or Abraded, NOC. 96. Terrorism 97. Repetitive Motion Carpel Tunnel Syndrome 98. Cumulative, NOC 99. Other - Miscellaneous, NOC