Navajo Nation Workers Compensation Program

General Information

Employee's Responsibility:

  • Complete and submit Report of Injury form to NNWCP
  • Report injury to supervisor and/or colleague
  • Seek medical attention, if needed
  • Submit doctor's statement to NNWCP and employer
  • Update NNWCP on follow up appointments

Supervisor's Responsibility:

  • Check on injured worker, recommend for medical attention
  • Make initial inquiries and investigation
  • Provide supervisor statement to NNWCP
  • If injured worker is incapacitated, complete and submit Report of Injury form to NNWCP
  • Submit supporting documentation

Required Documents/Forms include but are not limited to the following:
  • Employment Verification (document should include Effective Date, Employer Name, Title, Hourly Rate)
  • Accident or Police Report
  • Photographs of accident area and injury
  • Witness statement
  • Job description
  • Shift, Weekly, or Monthly schedules
  • Official Timesheets
  • Doctor/Work statement
  • Travel Authorization
  • Meeting Agenda and Sign In Sheets
  • Vehicle Mileage Log
  • Medical consent forms
  • Medical referral notices
  • Travel Expense Reports

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