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E. Dealing with an Injury, Illness, or Health Problem
Get Medical Care
If you’ve been injured on the job or off duty, get medical care right away. The most important thing is to attend to your injury! If you have a health problem, see a healthcare professional as soon as possible. As a fire fighter, you have healthcare coverage for your immediate needs and a variety of long-term disability benefits, but nothing is more important than getting the care you need right away. Like an unattended fire, injuries and persistent health problems only worsen when they aren’t taken care of as soon as possible.
Your doctor will:
- Attend to your immediate medical needs.
- Examine you and provide their opinion on the most likely cause of your injury/illness.
- Recommend any further treatment you may need.
- Fill out the Physician’s Initial Report (PIR) for your initial injury/illness visit.
- Fill out the Activity Prescription Form (APF), including the Key Objective Findings section.
- Work with you to decide when you can return to work.
When you see your doctor, make sure you clearly communicate the circumstances that led to your injury and that the injury is fully documented. This will help ensure your injury claim is properly reviewed, processed, and approved.
If you are unable to work as a result of your injury or occupational disease, you may qualify for time-loss compensation. These benefits are paid if you are unable to work for more than the three shifts (ten work days for members working an admin schedule) immediately following the date of your injury. To qualify, your healthcare provider must notify the City that your condition is work-related and that you are unable to work. Your provider must also provide objective findings to support their certification.
More information about time-loss compensation can be found in the “Workers’ Compensation” section.
Start Your Occupational Injury Claim
Once you’ve attended to your immediate healthcare needs, you must report your duty injury to your supervisor and begin filing the forms required to initiate your healthcare claim.
The checklist below will help you manage your claim. Additional information on these steps, your benefits, and filing claims follows below and in the other sections of this guide.
- Get medical care promptly (within 24 hours for an occupational injury or illness).
- Report your injury or exposure to your officer, the Disability Officer, or chain of command as soon as possible.
- Complete and file the required documentation for your type of injury. (Details follow below.)
- Communicate with your healthcare providers and ensure they have filed a Providers Initial Report (PIR) and Activity Prescription Form (APF) for your injury or illness.
- Stay in frequent contact with the Disability Officer and your case analyst at the City of Seattle Workers’ Compensation Division. If you can, update them on your progress weekly, preferably by email, so that everyone involved has an ongoing record of your case.
- Follow your treatment plan.
Report Your Injury or Exposure to Your Officer, Chain of Command, or the Disability Officer
You must report your occupational injury or exposure as soon as possible to your officer, chain of command, or the Disability Officer. If you want to maintain your privacy regarding your injury or exposure, you can report it directly to the Disability Officer (skipping your officer and chain of command). The Disability Officer is aware of personal medical privacy rights issues and will do their best to protect your privacy. If you intend to file an occupational claim, the Disability Officer must be informed about your occupational injury or exposure.
Collect, Complete, and File the Required Documentation
You and your physician must complete and file the following required documentation of your occupational injury or exposure within six calendar days of your visit to your physician or layoff:
| Form | Where to find it |
|---|---|
| Occupational Injury/Illness Report (Form 78) | This online form is available on Orion. |
| Provider’s Initial Report (PIR) | This form is available on the Hub. |
| Self-Insured Form (SIF-2) | This is a paper form. It’s available in your fire station. |
| Activity Prescription Form (APF) | This form is available on the Hub. |
| Communicable Disease Exposure Form (Form 407) | This form is available on the Hub. |
Additional information on each of these forms follows below.
The following table will help you determine which forms you need to submit for your injury or exposure:
Complete the Right Forms and Get the Right Signatures
| Type of Submission | What it means | Required forms due within 6 days |
|---|---|---|
| Precautionary | I don’t need to see a Dr. or miss work, but want to document this. | Form 78 |
| No Time Loss | I need to see a Dr. but I don’t need to miss work. | Form 78, PIR, SIF-2, APF |
| Time Loss | I need to miss work. A Doctor, LRNP, or PA needs to authorize any time loss. | Form 78, PIR, SIF-2, APF, and Form 407 if your time loss is due to Exposure |
| Exposure without time loss | I was potentially exposed to a contagious disease (such as COVID-19, Hepatitis, or Bacterial Meningitis); was exposed to excessive smoke, by-products of combustion, or noise. | Form 78, Form 407 |
This section will help you find and complete the correct forms, get them signed by the right people, and submit them to the appropriate people/organizations.
Occupational Injury/Illness Report (Form 78)
This online form is available on Orion.
The Occupational Injury/Illness Report (Form 78) is used to document occupational injuries and illnesses, including exposures. It provides a way for your supervisor to investigate, review, and comment on the specifics of an incident in an attempt to recognize accidents that may be prevented in the future. It must be completed for all occupational injuries, illnesses, and exposures.
The online form is available on Orion. It must be completed and submitted electronically. You must complete the Member section within one (1) year of the date of your injury, or two (2) years from the initial date of your illness. Once the form is submitted through Orion, your officer and the Disability and Safety Officers will receive an email asking for their review and signature of the form.
Note that the “case number” box should be left blank: the Orion system will assign the case number.
The Provider’s Initial Report (PIR)
This form is available on the Hub.
The Provider’s Initial Report (PIR) is completed by you and your physician. You should complete your section of the form before your initial visit to your physician. Your physician will complete their section of the form during your visit. The completed Provider’s Initial Report form establishes your claim with the City of Seattle.
Send your completed PIR to the Disability Officer as soon as possible after your initial visit.
Self-Insured Form (SIF-2)
This is a paper form. It’s available at your fire station.
The Self-Insured Form (SIF-2) is required by the Workers’ Compensation Unit for occupational injuries, illnesses, and exposures whenever a physician is seen, regardless of time loss or no
time loss. The Workers’ Compensation Unit uses the SIF-2 to open your claim. Once your claim is established, it serves to document the injury, illness, exposure, or health problem to enable the proper payment of medical bills and payment to you for time loss from work.
Be sure to thoroughly fill out and sign the Worker section. Your signature releases your medical records to the Fire Chief, his designees, and the City of Seattle’s Workers’ Compensation Unit.
The Employer section (including the signature and date at the bottom) can only be filled out by the Disability Officer. Make sure that your officer or chain of command does not add their signature to the Employer section.
You’ll find your claim number in the top right-hand corner of the SIF-2. The mailing address of the Workers’ Compensation unit is in the top left-hand corner of the form.
For billing purposes, you will need to give your claim number and the mailing address of the Workers’ Compensation Unit to your physician and/or medical establishment.
Keep the pink copy of the SIF-2 form for your records and submit the remaining copies to the Disability Officer. Do not leave this form at the physician’s office.
Activity Prescription Form (APF)
This form is available on the Hub.
The Activity Prescription Form (APF) is completed by you and your physician. The form must be completed and submitted to the Disability Officer within six calendar days of the injury. The Disability Officer will forward it to the City of Seattle Workers’ Compensation Unit.
Communicable Disease Exposure Form (Form 407)
This form is available on the Hub in the Lists section. If your device has access to the Hub, click here to get the form.
Completing and Routing Your Forms
Use the tables below to ensure you’re completing the proper forms and submitting them to the right person or department.
| Precautionary Submission | ||
|---|---|---|
| Forms Required | Completed By | Submit To |
| Occupational Injury/Illness Report (Form 78) | – You – Your officer, the Disability Officer, or chain of command | – Your officer, the Disability Officer, or chain of command |
| No Time Loss Submission | ||
|---|---|---|
| Forms Required | Completed By | Submit To |
| Occupational Injury/Illness Report (Form 78) | – You – Your officer, the Disability Officer, or chain of command | – Your officer, the Disability Officer, or chain of command |
| Self-Insured Form (SIF-2) | – You | – The Disability Officer |
| Physician’s Initial Report (PIR) | – Your Physician | – The Disability Officer |
| Activity Prescription Form (APF) | – You – Your Physician – Your officer, the Disability Officer, or chain of command | – The Disability Officer |
| Time Loss Submission | ||
|---|---|---|
| Forms Required | Completed By | Submit To |
| Occupational Injury/Illness Report (Form 78) | – You – Your officer, the Disability Officer, or chain of command | – Your officer, the Disability Officer, or chain of command |
| Self-Insured Form (SIF-2) | – You – Your officer, the Disability Officer, or chain of command | – The Disability Officer |
| Physician’s Initial Report (PIR) | – Your Physician | – The Disability Officer |
| Activity Prescription Form (APF) | – You – Your Physician – Your officer, the Disability Officer, or chain of command -Your Disability Officer | – The Disability Officer |
| Exposure Submission (With time loss) | ||
|---|---|---|
| Forms Required | Completed By | Submit To |
| Occupational Injury/Illness Report (Form 78) | – You – Your officer, the Disability Officer, or chain of command | – Your officer, the Disability Officer, or chain of command |
| Self-Insured Form (SIF-2) | – You – Your officer, the Disability Officer, or chain of command | – The Disability Officer |
| Physician’s Initial Report (PIR) | – Your Physician | – The Disability Officer |
| Activity Prescription Form (APF) | – You – Your Physician – Your officer, the Disability Officer, or chain of command | – The Disability Officer |
| Communicable Disease Exposure Report (Form 407) | – You | – The Disability Officer |
Stay In Touch With Your Team
Update your team on your progress weekly if you can, including the Disability Officer and your case analyst at the City of Seattle Workers’ Compensation Division. Frequent contact leads to better outcomes. It’s best to keep in touch via email so that everyone involved has an ongoing record of your case.
Notify the City of Seattle immediately if your address changes to avoid delays in receiving benefit checks or other claim-related correspondence.
Follow Your Treatment Plan
Cooperate with all reasonable requests from your healthcare provider, the City of Seattle, and others authorized to assist in your treatment and recovery.