What to do if you are injured at work in Puerto Rico

The CFSE runs Puerto Rico’s workers’ compensation system: coverage for a worker who is injured doing their job or who develops an occupational illness. It covers medical treatment at no cost to you, and it can pay you weekly compensation for as long as the doctor keeps you on leave. The thing to understand from day one is that this system is separate from everything else: your private health plan does not bill it, your employer does not process it for you, and it is not SINOT. SINOT covers illness and injury that do NOT come from work. The Fondo covers the ones that do. Filing in the wrong place is the most expensive mistake you can make here.

For a case to be compensable, the CFSE requires the accident to happen while you are performing duties of your job, at your workplace and during working hours. Self-inflicted injuries, accidents under the influence of alcohol or drugs, crimes committed by the worker, and gross negligence are excluded. Two clarifications the CFSE publishes resolve most of the doubts: if the accident happened away from the office, you are entitled if you were in an activity authorized by your employer, and you will need to present evidence of that authorization; and your commute from home to work is not covered, unless your employer authorized you in writing to work outside your regular area. One thing many people do not know: even if your employer has no active policy with the CFSE, you still have the right to file the claim.

• Notify your supervisor or employer immediately, so that they complete Form CFSE-373 (Employer’s Accident Report).Verified against the official source
• Go to a CFSE facility within five days of the accident. The CFSE publishes this deadline as calendar days on its steps page and as business days in its FAQ; count five calendar days so you are not exposed.Verified against the official source
• Valid photo identification.Verified against the official source
• The medical record, if you were already treated at a private institution or an emergency room.Verified against the official source
• Private health insurance card, if you have one.Verified against the official source

• Form CFSE-373 completed by the employer. It is the central document of the process.
• Form CFSE-1219, consent for treatment. You sign it at the Filing Office.
• Form CFSE-450.1, a sworn statement used only if the employer did not provide the Employer’s Report.
• Form CFSE-392, in which you commit not to work if the doctor places you on leave.
• Form CFSE-395, where the doctor records the determination about your leave and your return date. Give a copy to your employer as soon as possible.

1. 1

   Step 1: Tell your supervisor right away

   Tell your supervisor or employer what happened and ask them to complete Form CFSE-373, the Employer’s Accident Report. This is the step people skip when the injury seems minor and the hardest one to fix later: the later the notice appears, the more room there is for the case to be disputed. Report it even if you can keep working that day.

2. 2

   Step 2: If it is an emergency, go to the emergency room first and keep the record

   The CFSE says this explicitly: in a genuine emergency you may go to a private hospital or the nearest emergency room. What you cannot do is stop there. Keep a copy of the medical record and then report to the CFSE to continue treatment, because the person who has to evaluate you for the case is a CFSE-authorized doctor.

3. 3

   Step 3: Report to a CFSE facility within five days

   You can go to any dispensary, regional office or the Industrial Hospital. Bring the CFSE-373, your photo ID, the medical record if you were treated earlier, and your private health plan card if you have one. About the deadline, honesty is required: the CFSE steps page says five calendar days and its FAQ says five business days. Count five calendar days. If you arrive within the shorter window you satisfy both, and if you go past the shorter one relying on the longer, you are betting your case on which of the two pages wins.

4. 4

   Step 4: Go through Triage and then the Filing Office

   At Triage, nursing staff take your vital signs and assign you a turn, which does not necessarily follow arrival order. If it is an emergency you receive immediate medical attention and file afterwards. At the Filing Office your physical and electronic file is opened, you sign the CFSE-1219 treatment consent, you hand in the signed Employer’s Report, and you are given the CFSE-392. Your graphotype card is generated there and a primary doctor is assigned to you at random. Arrive early: the process has several stages in a single day.

5. 5

   Step 5: Get the medical evaluation and your follow-up appointment

   The doctor evaluates your condition, orders studies or prescribes medication if needed, and decides whether you should be on leave or return to work. That determination is recorded on Form CFSE-395. If you are prescribed something, the prescription is sent to a community pharmacy. Before leaving, stop at Medical Appointments, where you are given the date of your first appointment and the name of your primary doctor. If you were placed on leave, give a copy of the CFSE-395 to your employer as soon as possible.

At any CFSE dispensary, regional office, or the Industrial Hospital. The directory of locations is on the CFSE site. The phone numbers the CFSE publishes are 1-855-ELFONDO (1-855-353-6636) for injured workers, 1-844-PATRONO (1-844-728-7666) for employers and 1-844-POLIZAS (1-844-765-4927) for policies.

• Filing with SINOT instead of the Fondo. SINOT covers what does NOT come from work; a work injury goes to the CFSE.
• Not telling your supervisor because the injury seemed minor, and finding out weeks later that there is no Employer’s Report.
• Stopping at the private hospital’s care and not reporting to the CFSE within the deadline.
• Letting the five days pass trusting that the employer already reported it.
• Giving up when the employer will not fill out the CFSE-373, without knowing the Voluntary Report and the CFSE-450.1 exist.
• Assuming there is no claim if the employer has no policy.
• Not giving your employer the copy of the CFSE-395 when the doctor puts you on leave.
• Going back to work while on leave, after signing the CFSE-392 committing not to.

These are the government pages this guide is based on.

• Corporación del Fondo del Seguro del Estado (CFSE)

  Fondo del Seguro del Estado

  www.cfse.pr.gov

• Rights and obligations of the injured worker

  CFSE

  www.cfse.pr.gov

• CFSE frequently asked questions for injured workers

  CFSE

  www.cfse.pr.gov