Vermont Workers' Compensation Law
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Form 1 - ✔✔First Report of Injury- must be filed with the carrier within 72 hours of
receiving notice or knowledge of a claimed work-related injury that either a) causes an
absence of one day or more from work or b) requires medical attention
- must be filed even if the employer disputes the factual basis of the injury
- must be filed for first aid injuries as well
21 days - ✔✔amount of time from date the employer receives notice of the injury that
the carrier has to accept or deny a claim, regardless of the date that the employer
contacts the insurer
Form 2 - ✔✔Denial of Benefits- must be filed if the employer/carrier concludes that the
injury is not compensable within the 21 day period
- Department will deny this form if it is not filed with adequate support
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, - if it is not filed within the 21 day period and no extension was granted, the
Department may order employer/carrier to pay benefits
Form 10 - ✔✔must be filed in order to obtain the claimant's average weekly wage-
requires claimant to list dependents
Form 25 - ✔✔must be filed in order to obtain the claimant's average weekly wage-
records gross wages for the 26 weeks prior to the injury
- gross wages include income from concurrently held jobs- separate form must be
obtained from each employer
Temporary Partial Disability (TPD) - ✔✔if the injury results in eight or more days of
partial disability, claimant is entitled to these benefits- compensation rate is two-thirds
of the difference between the claimant's pre-injury AWW and the claimant's current
weekly wage
Temporary Total Disability (TTD) - ✔✔if the work injury results in three or more
missed days of work, the claimant is entitled to these benefits- compensation rate is two
thirds of claimant's AWW subject to maximum and minimum compensation rates-
entitled to $10 for any dependent
- if the claimant's AWW is below the minimum compensation rate, then it should be
90% of the AWW and they are not entitled to dependency benefits
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 2
Exam Questions and Answers 100%
Pass
Form 1 - ✔✔First Report of Injury- must be filed with the carrier within 72 hours of
receiving notice or knowledge of a claimed work-related injury that either a) causes an
absence of one day or more from work or b) requires medical attention
- must be filed even if the employer disputes the factual basis of the injury
- must be filed for first aid injuries as well
21 days - ✔✔amount of time from date the employer receives notice of the injury that
the carrier has to accept or deny a claim, regardless of the date that the employer
contacts the insurer
Form 2 - ✔✔Denial of Benefits- must be filed if the employer/carrier concludes that the
injury is not compensable within the 21 day period
- Department will deny this form if it is not filed with adequate support
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 1
, - if it is not filed within the 21 day period and no extension was granted, the
Department may order employer/carrier to pay benefits
Form 10 - ✔✔must be filed in order to obtain the claimant's average weekly wage-
requires claimant to list dependents
Form 25 - ✔✔must be filed in order to obtain the claimant's average weekly wage-
records gross wages for the 26 weeks prior to the injury
- gross wages include income from concurrently held jobs- separate form must be
obtained from each employer
Temporary Partial Disability (TPD) - ✔✔if the injury results in eight or more days of
partial disability, claimant is entitled to these benefits- compensation rate is two-thirds
of the difference between the claimant's pre-injury AWW and the claimant's current
weekly wage
Temporary Total Disability (TTD) - ✔✔if the work injury results in three or more
missed days of work, the claimant is entitled to these benefits- compensation rate is two
thirds of claimant's AWW subject to maximum and minimum compensation rates-
entitled to $10 for any dependent
- if the claimant's AWW is below the minimum compensation rate, then it should be
90% of the AWW and they are not entitled to dependency benefits
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 2
