Alaska Required Postings and Forms
In this state, claims are adjusted by Broadspire. Once a claim is reported to EMPLOYERS, the report will be sent to Broadspire for assignment. The contact information for Broadspire is:
P.O. Box 14348
Lexington, KY 40512-4348
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunchroom or time clock. If you have multiple office locations be sure to post the notices at each location.
- Employers Notice of Insurance – A printed copy of this form will be provided by EMPLOYERS. This should be posted in 3 conspicuous locations.
- Safety and Health Protection on the Job (English)
- Anti-Fraud Notice (English and Spanish)
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- Form 07- 6101 Employer Report of Occupation Injury or Illness to DWC. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within ten days from notice of a work-related injury. Fatalities must be reported within 24 hours. Please use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- Wage Statement. Should time loss be confirmed, the prior two calendar years of wages (W2s) will be requested, the better year will then be divided by 50 to establish the gross weekly rate. If you are unable to work and your injury has not been controverted, you should receive a check every two weeks representing your disability benefits. The amount of the check will depend on your gross weekly earnings which are calculated various ways depending on whether you are paid by the week, month, year, day or hour. Your weekly compensation rate will be 80% of your spendable weekly wage (gross weekly earnings minus payroll tax deductions), but is subject to certain limits.
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.