Important Information for NYSIF eFROI®

Once this electronic report is filed, it cannot be edited or resubmitted electronically.

If you have any questions about filing this report, please contact your NYSIF district office for assistance.

In order to successfully complete an Employer’s First Report of Injury via NYSIF eFROI®, you will need to have the following information. Please take a moment to review these items before filing an eFROI® report to insure accuracy. All fields marked with an asterisk (*) are required.

Policyholder Information:
  • Active policy number *
  • Mailing address and contact information *
  • E-mail Address *
  • Nature of Business *
Injured Worker/Employee/Claimant Information:
  • Name and Social Security Number *
  • Personal information, such as date of birth and gender *
  • Contact information, such as mailing address * and telephone number
  • Did employee give notice of accident/illness, If so, to whom? *
  • Injured employee’s supervisor’s name
Employment information:
  • Date of hire
  • Wage information – The injured employee’s gross average weekly wage *
  • Job title *
  • Employee’s usual days worked *
  • Time employee starts work
  • Date stopped working (the last day the injured employee was at work and ceased work activities because of this injury/illness)
  • Last day paid (The last calendar day the employee earned wages.)
  • How long employer will pay the employee?
    • (Will the employer pay the employee for any lost time due to the injury/illness?)
  • Return-to-work information, date and rate employee returned to work
Accident/Illness and Injury Information:
  • Date of the accident/illness or injury *
  • What was employee doing at the time of injury? *
  • How did the accident occur? *
  • Where did the accident/illness happen? *
  • Nature of the injury, such as laceration or fracture *
  • Body part(s) injured *
  • Cause of injury *
  • Any witnesses? If so, who?
  • Names, addresses, contact information for medical providers and/or hospitals from whom the injured worker received treatment
  • If employee received medical care, on what date? *
  • If accident involves the employer’s motor vehicle, all automobile insurance information is required
   
Report an Injury Using NYSIF eFROI®

Review a Prior NYSIF eFROI® Submission

You will need the following:

Report made after July 1, 2009:
  • NYSIF eFROI® Loss identification number a/k/a Claim number
  • NYSIF Policy number
  • Last four digits of the Injured Worker's SSN
Report made before July 1, 2009:
  • NYSIF eFROI® transaction number
  • NYSIF Policy number
  • Last four digits of the Injured Worker's SSN

Volunteer Firefighters  and Ambulance Workers

NYSIF eFROI® electronic web reporting is not able to accommodate injury/illness covered under the Volunteer Ambulance Workers’ Act or the Volunteer Firefighters’ Act at this time. You may complete a paper form:

  • Political Subdivision’s Report of Injury for Volunteer Ambulance Worker (Form VAW-2)
  • Political Subdivision’s Report of Injury for Volunteer Firefighter (Form VF-2)

Please print and mail a copy to NYSIF and to the WCB. Or you may call us at one of our NYSIF office phone numbers.