Extract data from ACORD 4 (2019/09) - Workers Compensation – First Report of Injury or Illness. Get data in JSON format to autofill another form, store in a database or convert to AL3 using WinsurTech solutions.
The ACORD 4 (2019/09) form, titled "Workers Compensation – First Report of Injury or Illness", is used to report the initial details of an employee's injury or illness that occurs in the workplace. It is typically submitted by the employer or an authorized representative to the workers' compensation insurer. The form includes critical information such as the nature of the injury or illness, the date and time of the incident, details about the employee (name, job, and contact), medical treatment provided, witness information, and the identity of the person reporting the incident. This standardized form helps ensure accurate and timely processing of workers' compensation claims, ensuring both the employee and employer are protected during the claims process.