Filing a Workmen's Compensation Claim
WHERE TO FILE:
Any employee or a petitioner on behalf of the employee interested in filing a workmen's compensation claim due to an injury or death at work must directly visit its employer's primary workmen's compensation insurance carrier.
PRIVATE SECTOR EMPLOYEES:
For employees employing with any businesses or employer of the private sector must seek and visit their employer's authorized workmen's compensation insurance carrier for guidance and instructions on filing a claim.
Territorial government employees:
The American Samoa Government (ASG) is considered a self-insurer employer. For ASG employees, report to your office's human resource manager; or, contact the Commission's Office for information and instructions on filing a claim.
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For those employed with ASTCA; DBAS; Feleti Barstow Public Library; Office of Visitors Bureau; and the Retirement Office - please contact your office's authorized local insurance carrier for further instructions.
HOW TO FILE A CLAIM
How to File a Claim before the commission:
Application form to file a workmen's compensation claim before the Commission, including forms for other related matters, can be found and acquire at the Commission's Office. These forms are also available online - Click here
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For filing an Injury Disability claim, use FORM WCC-01
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For filing a Death Benefit claim, use FORM DB-01
It is very important for the employee to complete all the requirements as instructed by the filing form. This includes the submission of necessary documentations, reports, and records as required by the application form and all other documentations as requested by the Commission's Office. Failure to comply and complete any set requirements may jeopardize the filing and outcome of your claim.
WHEN TO FILE A CLAIM
When to File a Claim:
A claim for compensation can be filed at any time after the first 7 days of disability following any injury, or within 1 year from the date of injury (see below for more information on Statute of Limitation).
FILING DEADLINE
(Statute of Limitation):
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The right to compensation disability shall be barred unless a claim thereof is filed within one year after the injury. [Sec. 32.06278(a)]
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The right to compensation for death shall be barred unless a claim thereof is filed within one year after the death or within one year after the dependents know or by exercise of reasonable diligence should know the possible relationship of death to the employment. [Sec. 32.0627(b)]
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Failure to file a claim within a year from the date of injury does not bar a claim from filing unless an objection on the statute of limitation is raised during the claimant's first informal hearing.