Mutual Society Accident Claim Form Chile (Solicitud de Atención por Accidente del Trabajo)

A Mutual Society Accident Claim Form Chile (Solicitud de Atención por Accidente del Trabajo) is the formal document by which a worker in Chile initiates coverage under the mandatory occupational accident and disease insurance system established by Ley 16.744 of 1968 — the Ley sobre Accidentes del Trabajo y Enfermedades Profesionales — and its procedural regulation, DS 101 of 1968. The claim form activates the obligation of the employer's mutual society (organismo administrador) to provide immediate medical attention, surgical care, hospitalisation, rehabilitation, and prosthetics at no cost to the worker, along with wage replacement benefits during incapacity.

Ley 16.744 established Chile's mandatory occupational injury insurance system with effect from 1 February 1969, creating a model based on employer-funded contributions administered through three mutual societies: the Asociación Chilena de Seguridad (ACHS), founded in 1958 and administered by SOFOFA-affiliated employers; the Mutual de Seguridad de la Cámara Chilena de la Construcción (Mutual de Seguridad CChC), serving the construction industry; and the Instituto de Seguridad del Trabajo (IST), serving diverse industries. Employers not affiliated with a mutual society fall under the Instituto de Seguridad Laboral (ISL), the public body under the Ministerio del Trabajo y Previsión Social that administers Ley 16.744 for unaffiliated workers.

Article 3 of Ley 16.744 defines a workplace accident (accidente del trabajo) as any injury caused by a sudden external cause during or as a consequence of the employment relationship — including accidents occurring on the route between the worker's home and the workplace (accidente de trayecto) under Article 5 inciso 2. An occupational disease (enfermedad profesional) is defined in Article 7 as any disease caused directly by the exercise of the profession or trade, resulting from chronic exposure to agents present in the work environment. The Ministerio de Salud (MINSAL) maintains the official list of recognised occupational diseases in DS 109 of 1968, and the Comisión Médica de Reclamos (COMERE) reviews disputed diagnoses under Article 77 of Ley 16.744.

The employer's mandatory contribution rate (cotización) under Article 15 of Ley 16.744 comprises a basic rate (cotización básica) of 0.93% of taxable remuneration plus an additional differentiated rate (cotización adicional diferenciada) of 0% to 3.4% determined by the activity's risk classification — with higher-risk industries (construction, mining, chemical processing) paying higher rates. The Superintendencia de Seguridad Social (SUSESO) supervises all organismos administradores under Ley 16.744, exercises appellate jurisdiction over disputed mutual society decisions under Article 77, and publishes circulares and resoluciones interpreting the system.

The Dirección del Trabajo exercises complementary jurisdiction over workplace safety obligations under the Código del Trabajo, Articles 184–210, including the employer's fundamental duty to take effective measures to protect the life and health of workers (deber de seguridad). Article 184 of the Código del Trabajo imposes a non-delegable, non-contractable obligation on every employer to provide safe working conditions, the necessary elements for self-protection, and training in occupational hazard prevention — and the Juzgados de Letras del Trabajo have jurisdiction over labour claims arising from employer failure to comply with this duty.

A Mutual Society Accident Claim Form Chile is needed immediately when a worker suffers any injury, illness, or condition arising from or in connection with their employment relationship. Article 3 of Ley 16.744 defines workplace accidents broadly — including injuries that occur while performing work duties, injuries caused by company equipment or machinery, accidents occurring on employer premises during work hours, and accidents on the direct route between the worker's habitual domicile and the workplace (accidente de trayecto) under Article 5 inciso 2.

The claim form is required whenever a worker believes a health condition is work-related, even if the connection is not immediately obvious. Occupational diseases under Article 7 of Ley 16.744 develop gradually — conditions such as hearing loss from chronic noise exposure (hipoacusia laboral), silicosis from silica dust in mining or construction, musculoskeletal disorders from repetitive motion, or dermatitis from chemical exposure are all recognised in DS 109 of 1968 and trigger the mutual society's obligation to investigate and provide coverage.

Workers in high-risk industries must file a claim form after any incident reportable under Articles 76–77 of Ley 16.744, which require the employer to report all fatal accidents and serious accidents (those causing permanent disability or hospitalisation) to the Servicio Nacional de Geología y Minería (SERNAGEOMIN) for mining incidents, or to the Inspección del Trabajo for other industries, within 24 hours. The employer must simultaneously file the DIAT with the organismo administrador.

The form is needed when a worker requires any of the benefits under Ley 16.744: free medical care (Article 29), free medications and rehabilitation (Article 30), prosthetic and orthopedic devices (Article 31), wage replacement as a subsidy por incapacidad temporal (Article 31) calculated at 100% of the last remuneration while the worker is receiving medical treatment, pension for partial permanent disability (pensión por invalidez parcial) if the incapacity reduces working capacity between 15% and 70% under Article 35, or full permanent disability pension (pensión de invalidez total) for incapacity exceeding 70% under Article 38.

A complete Mutual Society Accident Claim Form Chile under Ley 16.744 and DS 101/1968 must include the following essential elements to activate coverage and ensure the organismo administrador cannot reject the claim on procedural grounds.

Worker Identification: Full legal name, RUT (Rol Único Tributario assigned by the SII), date of birth, sex, nationality, and domicile of the affected worker, plus the worker's AFP pension fund and FONASA or ISAPRE health insurer — required under Article 71 of DS 101/1968 for proper registration of the incident in the Registro de Accidentes.

Employer Details: Legal name (razón social), RUT, registered address, economic activity (rubro), and the name of the organismo administrador (ACHS, Mutual de Seguridad CChC, IST, or ISL) to which the employer is affiliated under Ley 16.744. The employer's CIIU (Clasificación Industrial Internacional Uniforme) code determines the cotización adicional diferenciada applicable under Article 15 of Ley 16.744.

Date, Time, and Location of Accident: Precise date and time (DD/MM/YYYY; hh:mm hrs) of the incident and the exact location — whether the employer's premises, a construction site, a client location, or a trayecto route. Accidente de trayecto claims under Article 5 inciso 2 must be supported by evidence of the direct route (insurance declaration, transport ticket, GPS data) and the time must fall within a reasonable window of the start or end of the work shift.

Description of Accident: A factual narrative of how the accident occurred, including the activity being performed, the tools or machinery involved, the physical agents present (falls, impact, electric shock, chemical exposure, noise), and the immediate cause of injury. DS 101/1968 Article 71 requires specificity to enable the mutual society's investigation and determination of coverage.

Body Part and Nature of Injury: Identification of the affected body part(s) and the nature of the injury — contusion, fracture, laceration, burn, sprain, amputation, intoxication, or other. This information activates the International Classification of Diseases (ICD-10) coding by the mutual society's médico de urgencia for benefit calculation.

Witnesses: Names and contact details of any witnesses to the accident, required under DS 101/1968 for the organismo administrador's investigation. Witness declarations can be decisive in disputed coverage cases reviewed by the SUSESO under Article 77 of Ley 16.744 or by the Comisión Médica de Reclamos (COMERE).

Employer Declaration: The employer (or employer's representative with sufficient authority) must sign and stamp the DIAT within 24 hours of the accident under Article 71 of DS 101/1968. The employer's declaration that the accident occurred with occasion of the employment relationship is not a waiver of any defence, but creates an initial presumption of coverage that the organismo administrador must rebut with specific evidence if it intends to deny the claim.

Medical Treatment Requested: Indication of whether the worker requires emergency medical attention (atención de urgencia), outpatient consultation (atención ambulatoria), hospitalisation, diagnostic imaging, or specialist referral. The mutual society must provide free treatment at its own facilities (clínicas mutualistas) or at authorised network providers — refusal of medically necessary treatment can be appealed to SUSESO under the Circular 3220 of 2017.

Forms-legal.com provides this Mutual Society Accident Claim Form Chile template to help workers and employers document workplace incidents under Ley 16.744/1968. Every complex occupational injury or disease claim should be reviewed by a licensed Abogado specialising in seguridad social to assess entitlement to disability pensions and to challenge mutual society coverage decisions before SUSESO or the Juzgados de Letras del Trabajo. Los usuarios de forms-legal.com pueden descargar este documento de forma gratuita en formato PDF o DOCX, completar los campos del formulario guiado y obtener un documento listo para firma.