Welcome to BISD's Worker Compensation Resource Page

Injured on the job? Review the information below to learn what steps you should take next. 

Workers Compensation is a industrial insurance program managed by the Department of Labor and Industries. It's purpose is to aide employees who expirience a work-related injury or illness. Bainbridge Island School District is a self-insured member of the Olympic Educational Service District (OESD) #114 Workers' Compensation Trust risk pool. This allows our employees to file the necessary forms directly with the Workers Compensation Trust, who requests appropriate documentation from our district in response. We are here to guide you through the process and make sure that you have everything you need when injuries or illness occurs. 

Workers' Compensation Trust #114 Contact Information: 

Phone: 1-800-643-4369 or 360-782-5073

Email: Workcomp@oesd114.org

Address: Olympic ESD 114 Workers' Compensation Trust 105 National Ave N Bremerton, WA 98312

Fax: 888-558-1666

Injury or illness occurs on the job. Do I file a claim? 

If you experience an injury or illness on the job and you plan to seek medical treatment, you must file a claim. There are three ways to begin the claims process:

• Employee Incident Report (EIR):
  • This form will detail the specifics of the incident that occured and provide the claims adjuster with personal details needed to start a claim. 
  • This form is to be filled out by you and your supervisor.
  • Upon completion, send this form into your Workers' Compensation Trust (WCT) by fax, mail, or email. 
• Provider Initial Report (PIR):
  • This form will detail on the incident as well as personal information concerning your medical provider's diagnosis of the injury/illness and how it was related to work. 
  • This form is to be filled out by you and your medical provider the day of intial treatment for the injury. 
  • If not completed on day of intial treatment, a PIR must be completed and sent to the WCT within 5 working days of the visit. 
• Phone Accident Report:
  • A phone accident report is a written documentation of an incident taken by phone by the WCT directly. 
  • To begin, call the WCT and a claims adjuster will ask you all the questions needed to start the claims process.  

Start your claim here:

• Click here to submit a Employee Incident Report

 I have filed a claim. Now what?

Once a claim is filed, a WCT adjuster will send the injured worker a Injured Workers Packet. This packet includes:

• SIF2 Request
• Self-Insurer Accident Report (SIF2) (must be filled and returned)
• Information on Past Injury (must be filled and returned) 
• Provider Network and General Information
• L & I Workers’ Compensation Booklet
• Prepaid and Addressed Envelope
• Corvel Fill Prescription Form (Fill out and give to pharmacist)

Once the appropriate forms have been returned to the WCT, our District Office will be required to fill out the employer portion of the SIF2 form, a Health Benefit Information form, and an Annual Wage Information form. 

When is a claim allowed? 

There are two ways ways a claim can be approved for processing:

1. A signed application for benefits from your District Office – signatures can be obtained through completion
   of the SIF2 form.
2. Medical Support - The doctor completes a PIR which provides objective findings, diagnosis,
   and whether or not the conditions is work related on a more probable than not basis. An occupational disease claim may require additional investigation relating to
   the specific job duties of the worker before claim allowance.

My claim has been approved. Now what? 

You will receive an Activity Persciprtion Form (APF) from your medical provider upon each visit you have relating to your work injury. Your medical provider will notate what level of restrictions you will have as follows: 

• Full duty: Your medical provider releases you back to work without any restrictions. 
• Modified or light duty: Your medical provider releases you back to work with reduced hours or with restrictions on typical motions such as bending, lifting, and excessive motion. 
• Off work: Your medical provider has determined that you cannot return to work 

Along with these determinations, your medical provider will provide an approximate time frame that the restriction will be in effect for. This will be reevaluated upon each provider visit. 

When is my claim considered closed? 

Once the injured worker has reached maximum medical improvment and has returned to the job, the claim is processed for closure.