Workers' Comp.

Employee Statement of Injury

During the first week of April 2013, I became aware of a new records form that Management expects you to complete and sign when you report for treatment of an in-plant, work related injury. This is something new.

Some of this form consists of pretty standard "where does it hurt / how were you hurt" type questions.  However and as usual, the devil is in the details.  In this case a person, at the Plant Dispensary for an initial treatment of their injury will be expected to also provide witness names, give details of previous pain, problems or injuries and even determine your injuries category or nature.

These questions may seem harmless enough until you realize that they are being put to a person under the duress of a new painful, perhaps even critical injury. This form specifically states that completing it does not "make the injury/illness work related."  That is a not only a stupendous understatement but the reverse is a more likely outcome. Consider that your good faith response to a question about prior “pain or other…symptoms” may be used in a W/C hearing as your signed admission of previous illness or injury.

Normally, any visit to the Plant Dispensary will generate notes that include your description of how you came to be injured, what body part was involved, your observed symptoms, a diagnosis and a treatment plan. Since that is already the case, you might well ask yourself why you are being asked to complete and sign a confusing possibly incriminating form prior to receiving treatment.

Well, I wondered too and was told that the completion of this form is voluntary and there will be no repercussions if you opt to leave it blank. So, that is my advice. 

Leave it blank.


There are several things that are important for you to know if you get hurt at work.

Tell somebody, make sure that an accident report is written and ask for a copy.

If the company wants to send you to a medical facility, you must be aware that they are not promising to pay for your treatment .

You have a right to see your own doctor. If you feel more comfortable with your own physician, then you have a right to visit them for follow up treatment.

This is the most important thing. If you sign any papers that say Bureau of Workers' Compensation, you have just filed a claim. Read everything that you sign. Do not ignore this. If you start getting information in the mail about workers' compensation, take it to your representative for help. Either contact the union hall or a workers' compensation attorney. Always ask questions and don't ignore any paperwork that you are receiving.

REQUEST A COPY OF YOUR CLAIM FORM. Keep copies of everything. Don't assume that anybody else is taking care of this for you. It is your responsibility and you will eventually pay the price if you don't follow through.

If your plant injury disables you from working you should also call for sickness and accident papers. This will generate a benefit check while you are waiting for workers' compensation approval. Save a copy and make sure your forward all paperwork for us.

Union representation for Workers' Compensation is not automatic! You must sign up! If you wish Union representation - bring the copy of your claim form to the Union Hall along with copies of your sickness and accident form (if any). SIGN A R-2 REPPESENTATION CARD AT THE UNION HALL. If you retain an attorney the Union cannot represent you.

Normal Workers' Compensation hours at the Union Hall are 8:00 am - 4:00 pm.

NEVER, NEVER, NEVER go to a workers' compensation hearing by yourself. Do not ignore hearing notices. The company hires law firms to represent them and you can rest assured that they will be at that hearing, even if you are not.

The statute of limitations for the filing of an injury claim is two years. For an occupational disease it is two years after the first day of disability or such longer period not exceeding six months after diagnosis and opinion by a licensed physician.

If you need assistance, we are here to help. Phone number 330-538-2213 (ext 106) for the secretary, (ext 108) for the representative.


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