Which form is used in death cases to report to the Administrative Director?

Which form is used in death cases to report to the Administrative Director?

• A. DIA Form 510
• B. DWC Form 102
• C. AD Form 210
• D. Medical Form 505

Answer: (A)

When a death occurs in a self-insurance claim, the form used to notify the Administrative Director is DIA Form 510. This form is specifically designated for reporting death events in the workers’ compensation/SIP context, ensuring the Administrative Director receives the necessary details and can initiate the appropriate processing and investigations. Other forms serve different purposes within the system (general injury/illness reporting, administrative filings, or medical information), so they do not fulfill the death-reporting requirement to the Administrative Director.

When a death occurs in a self-insurance claim, the form used to notify the Administrative Director is DIA Form 510. This form is specifically designated for reporting death events in the workers’ compensation/SIP context, ensuring the Administrative Director receives the necessary details and can initiate the appropriate processing and investigations. Other forms serve different purposes within the system (general injury/illness reporting, administrative filings, or medical information), so they do not fulfill the death-reporting requirement to the Administrative Director.