To initiate a VSSR application, the Injured Worker must complete and file a Form IC 8/9.

A copy is sent to the Employer who can file an Answer within 30 days. The Staff Hearing Officer may grant an extension not to exceed 30 days for good cause.

From there, the application is sent to the BWC’s Safety Violation Investigation Unit (SVIU) for a report. The SVIU will ask the Employer to provide certain written documentation related to the incident, including:

1. Copy of Employer’s Accident or Injury Reports.
2. Copy of OSHA Records (e.g. 300; 300A; and/or 301); MSHA Records, and/or any other local state or federal records, pertaining or related to this investigation.
3. Written description of injury site, including equipment or machinery involved in the injury of record.
4. Date of purchase or equipment/machinery.
5. Manufacturer, model, and serial number of equipment or machinery involved.
6. Written description of use/operation of equipment or machinery involved.
7. Written description of construction site/area where injury occurred.
8. Copies of maintenance records for equipment or machinery involved in the injury of record.
9. Provide list of equipment supplied by the employer to the injured worker and the equipment supplied by the worker.
10. Provider training documents of the injured worker.
11. Provide names, addresses, and phone numbers of all witnesses.
12. Employer’s BWC Certificate of Coverage.
13. Employer’s Federal Tax Identification Number.

Next, the Employer and Injured worker meet with an SVIU investigator to give statements and present evidence. The investigator will then prepare and submit a written report to the Industrial Commission. After the report is mailed to all parties, the parties have thirty days to submit additional proof. Then, the Industrial Commission will set a mandatory pre-hearing conference to discuss any evidentiary issues and schedule a merit hearing.

After a 30-day period, a Staff Hearing Officer will review the evidence to determine whether any further action is warranted. The SHO must evaluate the totality of the evidence; no single piece of evidence can be viewed in isolation. Then, a formal record hearing will be scheduled for a taking of testimony. Following the hearing, the SHO will issue an order.

Requests for re-hearing may be filed within 30 days of receipt of the Staff Hearing Officer order. A rehearing may be appropriate if there is new and additional proof relevant to the claim that needs to be considered.

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