Use this as a private worksheet
Put the claim events in date order so missing records and deadlines are easier to see. This is not an official agency or court form.
Timeline
- ☐ Date: ______________________________
- ☐ Event: ______________________________
- ☐ Who was involved: ______________________________
- ☐ Document: ______________________________
- ☐ What changed: ______________________________
- ☐ Next question: ______________________________
Privacy reminder
Keep sensitive medical, wage, claim-number, and employment information private. Share it only with appropriate official agencies, licensed professionals, insurers, treating providers, or other people who legitimately need it for the claim.
Events worth placing on the claim timeline
- Injury, first symptoms, and report to the employer.
- First treatment, diagnosis, tests, referrals, and restriction changes.
- Claim forms, acceptance or denial notices, and treatment decisions.
- First missed work, modified duty, stopped payments, or wage changes.
- Calls, emails, portal messages, conferences, hearings, and settlement offers.
Print or save a clean copy after each major notice. Keep the source document beside the timeline so dates can be verified.