Injury Reporting

Parishioner or visitor injuries

To document any injury that a parishioner or visitor suffers at your location, use the Incident Report. This form can be emailed to [email protected] or you can call 1-800-228-6108 x2456 or x2441 to immediately report any injury. The Incident Report can also be used to notify your leadership of unsafe conditions, ensuring proper action is taken to rectify the situation. Completed Incident Reports should be kept on file at the parish or school. This file should be in a separate, locked location from personnel files.

Volunteer injuries

If a volunteer is injured performing duties at the direction of the church or school, please contact the Human Resources Department for the appropriate form. All incidents should be reported, regardless of whether medical treatment is necessary.

Employee injuries
We have recently changed insurance companies. Please refer to new contact information/reporting below:

Is the injury severe? 

Call 911 or safely transport injured person to nearest Emergency Room 

Severe injuries include: 

• significant blood loss

• unconsciousness

• broken bones

• a heart attack etc. 

Do you wonder if an injury requires medical or on-site treatment? 

Call ICW’s Nurse Triage Hotline 24/7 at (855) 469-6877. The nurse will let you know what type of treatment is needed to best help the injured person.  This service is available from both English or Spanish speaking nurses. 

Has the injured person already sought or refused medical care? 

Notify ICW or Reliable’s Claim Department. 

Injury Reporting Timeframe Guidelines: 

• Incident Only (where no medical treatment was sought): within 10 days 

• Injury (requiring any medical attention): within 3 business days 

• Severe Injury or Death: within 24 hours 

Claim Reporting options (Please reference First Report of Injury Form for required information that will be gathered at the time of reporting the injury (to either ICW or Reliable Claims Department)). 

• Phone #: (844) 442-9252 

• Online: https://claimsubmission.icwgroup.com 

Reliable Claims Department 

• Phone: (218) 729-6791

• Email: [email protected]

With any injury, no matter when you receive notice that the injury occurred, immediately follow these steps:

• fill out a First Report of Injury (FROI) and submit it according to the directions above;
• give a copy of the FROI to the employee along with an Employee Information Sheet.

Completed First Reports of Injury should be kept on file at your parish or school. Your location will be receiving information sent out by ICW in regard to the claim. All of these documents should be kept in a separate, locked location from the personnel files. 

OSHA requirements

If the injury is reportable under OSHA requirements, Human Resources will contact your parish or organization to fill out the required record-keeping documentation. In January of each year, Human Resources will assist qualifying locations with their OSHA Forms as required under Minnesota State Law.