External Workers' Compensation Process for OOS Employees in Vermont

Vermont

In the event of an on-the-job injury or illness occurring in the State of Vermont, please follow the below steps in order.

Step 1: Report the injury or illness to your supervisor immediately. Seek treatment with a medical provider of your choosing.

Step 2: Document your injury or illness as soon as possible by choosing one of the following options:

If you work for an agency that reports an injury, illness or near miss using the Workday system, logon to Workday. Select Report a Safety Incident within the Workday Safety application.

If your agency has not established an injury, illness or near miss reporting process or you are unaware of the process, please click on this hyperlink. Select Submit a New Risk Management Request, fill-in the fields on the form and select Out-of-State Safety Incident Report under the Type of Request drop down menu, then submit the form.

Step 3: Please complete the State of Vermont DOL FORM 5 immediately and send a copy to DAS Risk Management.

Step 4: File a claim with the appropriate insurance carrier. https://www.zurichna.com/claims Your claim will be managed by Zurich, our out of state insurance provider. You should expect a call from Zurich after the claim is filed. Please work with Zurich and provide them with any needed information during the life of your claim.

Please review this link Claims Filing | Department of Labor (vermont.gov) to help familiarize yourself with the claims process.

For any questions or concerns please reach out to DAS Risk Management

Mailing address:

PO Box 12009

Salem, Oregon 97309

Phone: 503-373-7475

Fax: 503-373-7337