Submitting a Work-Related Injury Claim

If you are the first doctor to diagnose a worker for an occupational injury or disease, you are responsible for completing the Providers Initial Report (PIR) and providing a copy to the self-insured employer, Puget Sound Workers’ Compensation Trust (Trust).

The Provider’s responsible for fully completing the Providers Initial Report (PIR):

(1) Fill out the PIR form completely. Leaving blank areas may delay processing of the claim and your bills. If the condition is a disease, enter “N/A” for “not applicable” in both of the following boxes:

  • Date of injury
  • Time of injury

(2) Be as specific as possible.

  • Include a complete diagnosis and appropriate Common Diagnostic Codes (ICD-10 codes). Clarify the specific body site and the definition of the injury.
  • If your patient is unable to perform any work due to the injury or disease, estimate how much time the injured worker will lose due to the injury.
  • The PIR must be signed by both you and your patient.

(3) Submit the PIR promptly with copies of the:

  • History and Physical.
  • Emergency room evaluation or your office notes.
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