Worker Injury Reporting for Employees of Self-Directed Participants

AmTrust Financial Services is the workers’ compensation insurance provider for all participants self-directing with Fello as their FMS provider. Fillable reporting forms are available on our website.

PLEASE NOTE: Accident investigation forms and statements should be filled out by the injured employee and supervisor/employer and accompanied by written documentation from any witness to the accident. Please try to conduct the preliminary investigation as soon as possible.

IMPORTANT: Care must be taken to ensure the investigation is fact finding, not fault finding. Obtaining signed statements as soon as possible following an accident ensures that you, the employer, have an accurate account of how the injury occurred. These completed statements are important in helping to correct hazards and prevent accidents from recurring. They also help to identify possible third-party liability as well as potential fraudulent claims.

After I have the forms completed — what do I do with them?

Please submit the forms to SDSEmployeeRelations@fello.org within 24 hours.

Please keep the completed forms for future reference, as an insurance adjuster may reach out to you requiring additional information. The completed forms are legal documents and contain valuable information in the claims investigation process of an injury and for building a case in the event of a workers’ compensation hearing.

What if my injured employee is physically unable to fill out the Employee’s Report of Injury?

Use common sense and good judgment. If the injury is severe, remember your employee’s health and care are first and foremost.

If possible, have the form filled out at a later, more appropriate time when the employee is physically able to document the accident. However, please submit the supervisor’s (employer’s) report as well as any witness statements to SDSEmployeeRelations@fello.org so the First Report of Injury can be submitted to our workers’ compensation insurance carrier.

What if my employee refuses to complete or sign an Employee’s Report of Injury?

You cannot require an employee to fill out the document. However, you can stress the importance of getting their account of the accident to help prevent the injury from happening again.

You must still complete the supervisor’s (employer’s) report as well as any witness statements and submit them to SDSEmployeeRelations@fello.org.

What if my employee has retained an attorney — can I still ask the injured employee to fill out an Employee’s Report of Injury?

Yes. As part of your company’s accident management plan, you may still ask the employee to complete the report form.

However, you may not speak with the attorney. Only the Workers’ Compensation Insurance Adjuster should communicate with the attorney.

Rev. 1/26/2026