Workers Compensation Medical/Loss Time
|
|
- Aubrey Chapman
- 8 years ago
- Views:
Transcription
1 Workers Compensation Medical/Loss Time If you are injured while at work and are planning to seek immediate medical attention or end up seeking medical attention please make sure to read all the information below. - Please make sure that you have noted on the Accident Report Form that you are going to a Dr. to be seen for your work related injury. o Also contact the Human Resources office at to notify us prior to being seen as some Dr. s offices require pre-approval from our workers compensation company for your visit. - If you are going to be out due to a work related injury: o you need to make sure to have a note from your treating physician putting you out of work o please have this note faxed to the Human Resources office at If you are managing your own care for your work related injury: o please make sure that both Meadowbrook TPA Associates and the Human Resources Office receive updates from your treating physician o The treating physician may fax us at: Meadowbrook Human Resources Once your physician has cleared you to return to work: o Fax the return to work information to both Meadowbrook TPA Associates and the Human Resources Office. o If there are restrictions with your return to work the Human Resources Office will go over these restrictions with your department to make sure they are able to accommodate the restriction and the Human Resources Office will contact your directly to confirm your return to work date. - If you would like to make changes or stop any of your Wellesley College benefits while you are out of work, please contact our Benefits Specialist at Please make sure to provide your Dr. s offices with our workers compensation company information below. You will receive a confirmation letter from Meadowbrook when your claim has been approved which will include a claim number to provide to your Dr. s office for billing purposes. o Any bills that you receive directly should either be forwarded by you to Meadowbrook or you should contact your physician s office to have them redirect the bills to Meadowbrook. Meadowbrook TPA Associates 10 New England Business Center Suite 303 Andover, MA Main # Fax #
2 - While you are out due to your work related injury you must make arrangements with the Human Resources Office to pay for the employee portion of your health and/or dental benefits, if applicable. Benefits Payment Options: Please check off which option you would prefer and return this form to the Human Resources office by fax, mail or drop off. Please supplement my time with sick/vacation/personal time so that I am receiving full pay while I am out due to my work related injury. Please supplement my time with sick/vacation/personal time to cover my health/dental benefits. I do not wish to supplement my time and please bill me for my portion of my health/dental benefits. **If you run out of time to continue to supplement we will then start to bill you for your portion of your health and/or dental benefits. If you have questions/concerns about paying for your benefits please contact our Benefits Specialist at Important - Please Read: If the Human Resources Office does not receive this form or hear from you directly then you will go into an unpaid status and will be automatically billed for you benefits. Please feel free to call us at with any other questions or concerns. Employee Signature Date Print Name
3 Page 1 of 1 Accident Reporting Form Today s Date: Employee Name Incident Date Employee Information Job Title Shift Current Mailing Address Home Phone Cell Phone Date of Hire Department Date of Birth Employee Signature (if available): Date: Incident Description Supervisor Reported To Witnesses Location where injured Medical Treatment Required: Treating Physician/Facility Yes No Incident Detail Address Phone Number Injury Description Body Part Side of Body Type of Injury (i.e. sprain/strain, bruise) Will you lose any time due to this injury? Yes No First day out of work: Notes/ Comments Please put in any additional information here: When completed please fax form to the Human Resources office at and to the Health and Safety Department at
4
5 Our Worker's Compensation provider is Occupational Health Center/ Beth Israel Deaconess Hospital/ Needham Campus. We welcome the opportunity in working with Occupational Health Center. For more information, please call HR X3303 Occupational Health Center at Beth Israel Deaconess Hospital / Needham Campus Partnership for a Healthy Workplace 148 Chestnut Street Needham, MA (781) Treatment Services Urgent Care Lacerations Contusions Strains/sprains Minor fractures Eye injuries Rehabilitation Physical therapy Hand therapy Work conditioning Repetitive strain injuries Occupational therapy Specialty Services Second opinions Functional capacity exams (FCE) Independent medical evaluation Case Management Chemical exposure Prevention and Assessment Services Exams Annual physicals DOT physicals Drug & alcohol Fit-for-duty Hearing Pre-placement Pulmonary function Other Immunizations/vaccinations Job analysis Medical surveillance (OSHA requirements) Ergonomics-lab and office Body mechanics training Bloodbome pathogens training Health Education and Promotion Instructional Series CPR First aid Cholesterol Smoking Cessation Stress Management Screening Clinics Breast exams Cardiac risk factors Cholesterol Glucose Podiatry Prostate Skin cancer Lectures Elder issues Exercise Heart health Infectious disease Nutrition Parenting Women's health How to Access The Occupational Health Center *Monday through Friday, 8:00 a.m. - 4:30 p.m. (Clinic hours) Contact Shannon Stark at (781) ; FAX: (781) Emergency Department 4:30 p.m. - 8:00 a.m. (Weekdays, weekends and holidays) (781) *** See attached map *** From North, West and East Take Route 128 South to Exit 19B. Proceed on Highland Avenue for approximately 1.5 miles Bear right onto Chapel Street. Cross Great Plain Avenue onto Chestnut Street. Follow Chestnut Street for one block. The Hospital is on the left, just past the Fire Station and the intersection with School Street From the South: Take Route 128 to Exit 17. Turn right onto Route 135. Proceed approx 1.6 miles along Dedham Avenue (Route 135). Bear left onto School Street and follow to end at Chestnut Street. Take left onto Chestnut Street. Public Transportation: MBTA Commuter Rail-Needham Line, stops at the Needham Junction station, Monday through Saturday. The Hospital is located mile east of the Needham Junction station on Chestnut Street. MBTA Bus Line, Route 59, also provides transportation service (Monday through Saturday) from Watertown Square, via Newtonville, to Beth Israel Deaconess Hospital-Needham Campus on Chestnut Street.
6 Starting from: 106 Central Street, Wellesley, MA Arriving at: 148 Chestnut Street, Needhan, MA Directions Distance Total Est. Time: 11 minutes Total Est. Distance: 4.00 miles 1: Start out going EAST on CENTRAL ST / MA-135 toward CROSS ST. Continue to follow MA miles 2: Turn RIGHT onto WELLESLEY AVE / MA-135. <0.1 miles 3: Turn SLIGHT RIGHT onto BROOK ST. 0.9 miles 4: Turn RIGHT onto GREAT PLAIN AVE / MA-135 E. 2.3 miles 5: Turn RIGHT onto CHESTNUT ST. 0.1 miles 6: End at 148 Chestnut St Needham, MA , US Total Est. Time: 11 minutestotal Est. Distance: 4.00 miles
MOHA Midwest Occupational Health Associates
MOHA Midwest Occupational Health Associates Healthy Employees, Healthy Business MOHA Springfield Clinic MOHA Midwest Occupational Health Associates Realize the Future of Corporate Health Care Now Effective
More informationWhat are the benefits?
Case Study provides onsite medical services for improved care and increased savings. Oil & Gas Medical Services Overview Accessible, quality medical care for healthier employees! s system of delivering
More informationHealthcare Associates Caring for You
Healthcare Associates Caring for You Welcome to Healthcare Associates Dedicated to You At Healthcare Associates (HCA), patients come first, and caring for you is what we do best. We are pleased to offer
More informationWORKERS COMPENSATION CLAIM REPORTING PROCEDURES
WORKERS COMPENSATION CLAIM REPORTING PROCEDURES 1. Complete the enclosed First Report of Injury to ensure that you will have all of the appropriate questions answered during the reporting process. Have
More informationSouth Suburban Occupational Medicine Jeffry N. Gerber, M.D., Level II Certified 7780 South Broadway Suite 250 Littleton, Colorado 80122
South Suburban Occupational Medicine Director of Risk Management Workmans Compensation Dear Risk Manager, On behalf of the staff and myself, I want to welcome you to our practice. I invite you to explore
More informationhat If? What should I do if an injury occurs?
hat If? Q: What should I do if an injury occurs? A: How to respond to an on-the-job injury and how to ease back into work through the Transitional Work Program. Q: hat? What should I do in case of injury?
More informationAccident/Incident & Workers Compensation. Packet
Accident/Incident & Workers Compensation Packet Accident/Incident & Workers Compensation Program The following information is to assist you in completing the Accident/Incident & Workers Compensation Program
More informationHANOVER COUNTY PUBLIC SCHOOLS
POLICY The School Board provides Workers Compensation insurance coverage at no cost to employees. This insurance program covers an injury (by accident) or illness (occupational disease) which arises out
More informationEmployee Guidelines for Workers Compensation Accidents
Employee Guidelines for Workers Compensation Accidents The information included in this packet will become important to you in the event that you seek medical attention or lose time from work due to a
More informationWorkers' Compensation CLAIMS KIT
Workers' Compensation CLAIMS KIT CLMCVR ATTENTION WORKERS' COMPENSATION POLICYHOLDERS! Thank you for placing your Workers' Compensation insurance through CIA Managing General Agency. The carrier for your
More informationInjury Report Instructions
Injury Report Instructions The numbers refer to question numbers on the form that may require additional explanation. Worker Details 1 Have your work duties been modified? Your duties have been modified
More informationWHAT SHOULD I DO IF I HAVE A WORK-RELATED INJURY?
WHAT SHOULD I DO IF I HAVE A WORK-RELATED INJURY? 1) In a serious emergency, call 911 or go to the nearest hospital/trauma center! Follow-up care is to be arranged with one of the district s designated
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3952 Y0041_H3952_KS_15_18734 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationHow To Get Paid For An Accident On The Job In South Carolina
SOUTH CAROLINA BAR Workers Compensation and the Law WORKERS COMPENSATION The South Carolina Workers Compensation Act provides a system for workers injured on the on the job to receive medical care and
More informationCollaborative Onsite Medical Care in the Workplace
Collaborative Onsite Medical Care in the Workplace Sue Dierksen, MPH,RN, COHN-S/CM, CSP Director of Business Health- Aspirus Clinics Holly Bauer, RN BSN Health Services Supervisor, Sentry Insurance Objectives
More information1.2.1. Call ASC-HRM-WC if you have questions @ 877-372-7248 option [2] for HRM, then option [2] for Forest Service Employees.
Incident Process for Traumatic Injuries or Occupational Disease This document addresses all work related injuries, including serious burns. This same process will be followed when an employee suffers a
More informationMercy Business Health Services Fall 2005 Newsletter
Mercy Business Health Services Fall 2005 Newsletter Healthy Businesses Build Healthy Communities Mercy Health2Work - Improving Your Employee Health Start 2006 by making a healthy investment in your company!
More information2015 Summary of Benefits
2015 Summary of Benefits Effective January 1, 2015, through December 31, 2015 H3909 Y0041_H3909_PC_15_18889 Accepted 09/01/2014 Section I: Introduction to Summary of Benefits You have choices about how
More informationReporting Injuries 1
Reporting Injuries 1 Reporting Injuries Supervisors must investigate and implement corrective actions ASAP. Immediately report all work related injuries to your supervisor! 2 Illness or Injury to Faculty/Staff
More informationOSHA & Workers Compensation Requirements Recording Workplace Injuries & Illness
Human Resources 30-71 7/15/91 3/25/02 1 of 7 OSHA & Workers Compensation Requirements Recording Workplace Injuries & Illness VPSI, Inc. is subject to the record-keeping requirements of the Occupational
More informationSTANDARD TORT CLAIM FORM PACKET
STANDARD TORT CLAIM FORM PACKET Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. DOCUMENTS CONTAINED IN THE STANDARD TORT CLAIM FORM
More informationOccupational Injury / Illness Report
Occupational Injury / Illness Report This report must be completed whenever a Franklin & Marshall employee, including a student worker, is injured or becomes ill during the course of his/her employment
More informationINCIDENT REPORTING POLICY
INCIDENT REPORTING POLICY Revised April 2011 1 Incident Reporting Policy Introduction This policy has been developed to detail the standards to be applied following an accident or incident at Northumbria
More informationJanuary 1, 2015 December 31, 2015 Summary of Benefits. Advantra (HMO) H3928-001 80.06.360.1-LA1
January, 205 December 3, 205 Summary of Benefits H3928-00 80.06.360.-LA Y0022_205_H3928_00_LA Accepted 9/204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of what we
More informationMANUAL OF UNIVERSITY POLICIES PROCEDURES AND GUIDELINES. Applies to: faculty staff students student employees visitors contractors
Page 1 of 5 Title/Subject: CMU ERGONOMICS PROGRAM Applies to: faculty staff students student employees visitors contractors Effective Date of This Revision: May 1, 2012 Contact for More Information: Human
More informationWorkers Compensation
STARK COUNTY COMMISSIONERS HUMAN RESOURCES DEPARTMENT 110 CENTRAL PLAZA SOUTH SUITE 240 CANTON, OHIO 44702 Phone: 330.451.7371 Workers Compensation Supervisor Responsibilities 1) ASSIST the injured worker
More informationEssentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 25 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 25 (HMO-POS). Next year, there will
More informationStandard Tort Claim Form Packet
Standard Tort Claim Form Packet Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. Presenting a Standard Tort Claim Form RCW 4.96.020
More informationKUMC. Medical Surveillance Program
KUMC Medical Surveillance Program INTRODUCTION Employees at KUMC could potentially be exposed to safety hazards such as chemical, biological, and physical hazards. These hazards are most likely to occur
More informationHUMAN RESOURCES MANAGEMENT POLICY WORKERS COMPENSATION. Policy 27
HUMAN RESOURCES MANAGEMENT POLICY WORKERS COMPENSATION Policy 27 NOTE: THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE MEDICAL UNIVERSITY OF SOUTH
More informationWhat injuries should you report to WCB?
Employer Report of Injury Important Information How soon should you report injuries to WCB? As soon as possible. Research shows the longer the delay in reporting and managing an injury, the higher the
More informationStonebridge Adult Medicine, P.A. Registration Form (Please Print)
Stonebridge Adult Medicine, P.A. Registration Form (Please Print) PATIENT INFORMATION Last Name: First Name: Is this your legal name? Yes No If not what is your legal name: Date of Birth: Sex: male female
More information(This is a sample of the injury packet that GENEX will customize for each employer)
Ohio Workers Compensation Injury Packet (This is a sample of the injury packet that GENEX will customize for each employer) Employer: «Employer» «Address1» «City», «ST» «Zip» Phone #: «Phone» BWC Policy
More informationPresent in Person or Mail the Standard Tort Claim Form and Supporting Documents to:
Standard Tort Claim Form Washington State law (Chapter 4.96 RCW) requires a Standard Tort Claim Form to be submitted when filing a tort claim against the Bellevue School District. Standard Tort Claim forms
More informationINSTRUCTIONS FOR COMPLETING A TORT CLAIM FORM. General Liability Claim Form #SF 210
Standard Tort Claim Form Packet Washington State law (Chapter 4.96 RCW) requires a Standard Tort Claim Form to be submitted when filing a tort claim against the Franklin Pierce School District. Standard
More information2015 Summary of Benefits
2015 Summary of Benefits Plans 003 and 004 H6298_14_027 accepted Summary of Benefits January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn t list
More informationACCIDENT / INJURY REPORTING PROCEDURES FOR GEORGIA STATE UNIVERSITY
ACCIDENT / INJURY REPORTING PROCEDURES FOR GEORGIA STATE UNIVERSITY FOR ANY LIFE THREATENING EMERGENCY ** SEEK TREATMENT IMMEDIATELY THEN FOLLOW THE PROCEDURES THAT FOLLOW **LIFE THREATENING EMERGENCIES
More informationJanuary 1, 2015 December 31, 2015 Summary of Benefits. Altius Advantra (HMO) H8649-003 80.06.361.1-UTWY A
January, 205 December 3, 205 Summary of Benefits H8649-003 80.06.36.-UTWY A Y0022_205_H8649_003_UT_WYa Accepted /204 Summary of Benefits January, 205 December 3, 205 This booklet gives you a summary of
More informationWORKERS COMPENSATION FORMS CENTRAL STORES COMMODITY CODES
WORKERS COMPENSATION FORMS CENTRAL STORES COMMODITY CODES Employer s Report of Occupational Injury/ Illness (5020) 7673 Authorization to Release Records (WC10) 7697 Workers Compensation Benefit Election
More informationEssentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare
Essentials Choice Rx 24 (HMO-POS) offered by PacificSource Medicare Annual Notice of Changes for 2016 You are currently enrolled as a member of Essentials Choice Rx 24 (HMO-POS). Next year, there will
More information2016 Summary of Benefits
2016 Summary of Benefits Health Net Violet Option 3 (PPO) Douglas and Josephine counties, OR Benefits effective January 1, 2016 H5520 Health Net Life Insurance Company H5520_2016_0202 CMS Accepted 09162015
More informationTITLE: Department Orientation / Competency Requirements/Skills Checklist 1 OF 1
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER DEPARTMENT OF SURGERY POLICY AND PROCEDURE REVISION: Sept 30, 2009 NUMBER 2.5 PREPARED BY: LANE A. BEASLEY ADMINISTRATOR APPROVED BY: JOHN GRISWOLD, M.D. CHAIRMAN
More informationWorkers Compensation. Your Guide to Handling Worker s Compensation Reporting and Filing
Workers Compensation Your Guide to Handling Worker s Compensation Reporting and Filing Filing Worker s Compensation Claims Compensation Claims When the department is notified of an employee s work-related
More informationIndependent Health s Medicare Passport Advantage (PPO)
Independent Health s Medicare Passport Advantage (PPO) (a Medicare Advantage Preferred Provider Organization Option (PPO) offered by INDEPENDENT HEALTH BENEFITS CORPORATION with a Medicare contract) Summary
More informationRIDGE PHYSICAL THERAPY & WELLNESS CENTER. Intake Form
Intake Form : Personal Information please print clearly Name: last first middle initial Home Address: Home Telephone: ( ) Cell Phone: E-Mail Address: Social Security #: of Birth: Age: Sex: M F Marital
More informationSummary of Benefits. Prime (HMO-POS) and Value (HMO) January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE 1-888-408-8285 (TTY: 711)
Summary of s and January 1, 2015 December 31, 2015 G ENERATIONS A DVANTAGE For more information about benefits or enrollment, call us or visit our website at www.martinspoint.org/medicare. 1-888-408-8285
More informationSuperintendent s Circular
Superintendent s Circular School Year 2011-2012 NUMBER: HRS-PP7 DATE: WORKERS COMPENSATION PROCEDURES OBJECTIVE The Boston Public Schools Workers Compensation Service is located within Boston City Hall,
More informationALL INJURIES MUST BE REPORTED WITHIN 24 HOURS OF THE INCIDENT TO BOTH THE SITE ADMINISTRATION AND THE CALL CENTER.
REGULATION TITLE: Reporting Industrial Injuries or Illness Tucson, Arizona POLICY REGULATION CODE: GBGC-R1 ALL INJURIES MUST BE REPORTED WITHIN 24 HOURS OF THE INCIDENT TO BOTH THE SITE ADMINISTRATION
More informationInstructions for Incident Reports
(rev 11/2009) Instructions for Incident Reports Whenever an incident occurs: An Incident Report form must be completed immediately after an incident occurs and couriered to appropriate Medical/Dental Director
More informationReferrals It is your responsibility to bring your referral if required. Failure to do so may result in cancellation of your appointment.
Welcome to Capital Endocrinology! We are happy to have you as a patient in our practice. Please take note of the following policies. Following these policies will help in making your visit as efficient
More informationEmployer s Report of Injury or Occupational Disease form attached
Employer s Report of Injury or Occupational Disease Important Information How soon should you report injuries to WCB? As soon as possible. Research shows the longer the delay in reporting and managing
More informationStandard Tort Claim Form Packet
Standard Tort Claim Form Packet Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. A New Law that Impacts Presenting a Standard Tort
More informationSummary of Benefits Community Advantage (HMO)
Summary of Benefits Community Advantage (HMO) January 1, 2015 - December 31, 2015 This booklet gives you a summary of what we cover and what you pay. It doesn't list every service that we cover or list
More information[2015] SUMMARY OF BENEFITS H1189_2015SB
[2015] SUMMARY OF BENEFITS H1189_2015SB Section I You have choices in your health care One choice is to get your Medicare benefits through Original Medicare (fee-for-service Medicare). Original Medicare
More informationBrigham and Women s Hospital Human Resources Policies and Procedures
Brigham and Women s Hospital Human Resources Policies and Procedures SUBJECT: POLICY #: EMPLOYEE WORK-RELATED INJURY AND ILLNESS REPORTING HR-405 Effective Date: January 1, 2008 Revised: January 1, 2013
More informationWe thank you for your business, and look forward to providing you with the necessary protection and care for your business and employees.
RE: Workers Compensation Claims Kit Welcome to the Workers Compensation Insurance Program offered through Tower Group Companies. While we hope that your company never has to experience a workers compensation
More informationTHE EMPLOYEE S ROLE: When an Employee is Injured on the Job. Human Resources Management Workers Compensation Program
THE EMPLOYEE S ROLE: When an Employee is Injured on the Job Human Resources Management Workers Compensation Program August 16, 2010 This guidebook gives an overview of the California workers compensation
More informationCLAIMS REPORTING TO REPORT AN INJURY CALL 1-866-274-6033. 24 hours a day / 7 days a week
CLAIMS REPORTING TO REPORT AN INJURY CALL 1-866-274-6033 24 hours a day / 7 days a week You will need the following information to report a claim. However, do not delay reporting if you are missing information.
More informationTHE SUPERVISOR S ROLE:
THE SUPERVISOR S ROLE: Workers Compensation Information for CSU, Los Angeles Supervisors Human Resources Management (HRM) Workers Compensation Program August 16, 2010 Table of Contents Introduction..3
More informationReporting Work-Related Injuries and Illnesses
Page #: 1 of 14 Last Reviewed/Update Date: 12/10/14 Reporting Work-Related Injuries and Illnesses 1. Purpose / Background This SOP describes procedures for reporting work-related injuries and illnesses
More informationWorker s Compensation. What to do when an employee is injured at work.
Worker s Compensation What to do when an employee is injured at work. OCM BOCES is subject to New York State Worker s Compensation Law If an injury requires treatment by a medical provider, The BOCES must
More informationFIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits. FirstMedicare Direct PPO Plus (PPO)
FIRSTCAROLINACARE INSURANCE COMPANY 2015 Summary of Benefits FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties 1 P age SECTION I - INTRODUCTION TO SUMMARY
More informationStandard Tort Claim Form Packet
Standard Tort Claim Form Packet Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. A New Law that Impacts Presenting a Standard Tort
More informationSummary of Benefits January 1, 2016 December 31, 2016. FirstMedicare Direct PPO Plus (PPO)
Summary of Benefits January 1, 2016 December 31, 2016 FIRSTCAROLINACARE INSURANCE COMPANY FirstMedicare Direct PPO Plus (PPO) Chatham, Hoke, Lee, Montgomery, Moore, Richmond, Scotland Counties This booklet
More informationFirst Steps in the Claims Process: Insurers
First Steps in the Claims Process: Insurers First Steps - Insurers Insurer notified of injury by employer, employee or 3 rd party Contact the worker and employer within 3-days Consult with relevant parties,
More informationWorkers Compensation
Workers Compensation All work-related injuries or illnesses must be reported. If the injury is an emergency, arrange for appropriate medical treatment. The employee has the right to select his or her own
More informationPUD No. 1 of Clallam County Standard Tort Claim Form Packet
Standard Tort Claim Form Packet Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. A New Law that Impacts Presenting a Standard Tort
More informationRadiation Oncology Patient & Family Guide
Radiation Oncology Patient & Family Guide 1 Radiation Oncology Patient & Family Guide The Radiation Oncology department is part of the Cleveland Clinic Cancer Center at Hillcrest Hospital. The department
More informationWORKERS COMPENSATION/PRIVATE INSURANCE COVERAGE FOR LEARNERS ON UNPAID TRAINING PLACEMENT
WORKERS COMPENSATION/PRIVATE INSURANCE COVERAGE FOR LEARNERS ON UNPAID TRAINING PLACEMENT OVERVIEW Effective July 1, 1993, all students (learners) in unpaid training placements who are placed in agencies
More informationSafe Operating Procedure
Safe Operating Procedure (Revised 10/15) ON-THE-JOB AND STUDENT INJURIES Responding to Injuries General guidance for immediate response actions for injuries and illnesses follows. As with all emergency
More informationFor updates on our telephone and office hours, please visit us at www.bidmc.org/pcpaponte.
Dear Patient, On behalf of all of us at Beth Israel Deaconess HealthCare, I would like to welcome you to my practice. I am pleased that you have chosen me as your Primary Care Physician (PCP). Beth Israel
More information2015 Summary of Benefits
2015 Summary of Benefits Health Net Healthy Heart (HMO) Placer and Sacramento counties, CA Benefits effective January 1, 2015 H0562 Health Net of California, Inc. Material ID # H0562_2015_0273 CMS Accepted
More informationCentral State University (CSU) ACCIDENT PROCEDURE
Central State University (CSU) ACCIDENT PROCEDURE Note: Copies of all injury reporting packets are located in your department office and/or Human Resources Department. Complete this form when the answer
More informationHow To Get Paid For An Injury At Work
INCIDENT PROCESSING OF INJURIES OR ILLNESSES FOR US FOREST SERVICE (USFS) EMPLOYEES ONLY The instructions below are to be utilized on wildland fires and other emergency incidents. This document addresses
More information#6-604 Accident Reporting Policy Page 1 of 5
Page 1 of 5 Approved By: Cabinet Effective Date: January 2, 2013 Category: Contact: Human Resources Assistant Vice President for Human Resources (585) 245-5516 I. PURPOSE This document outlines the policies
More informationSUB-CONTRACTOR/VENDOR PRE-QUALIFICATION QUESTIONNAIRE
Page 1 of 7 SUB-CONTRACTOR/VENDOR PRE-QUALIFICATION QUESTIONNAIRE GENERAL INFORMATION 1. Company Name/Contractors License No.: Telephone: SIC(s): Street Address: Mailing Address: 2. Officers: Years With
More information5.42.2 Designated Workers Compensation Facilities
5.42 Workers Compensation Policy (adopted May 12, 2014) The College provides Workers Compensation benefits for all College employees pursuant to the mandates of the Missouri Workers Compensation Law. Employees
More informationANNUAL NOTICE OF CHANGES FOR 2016
Cigna-HealthSpring Preferred (HMO) offered by Cigna-HealthSpring ANNUAL NOTICE OF CHANGES FOR 2016 You are currently enrolled as a member of Cigna-HealthSpring Preferred (HMO). Next year, there will be
More informationRisk Management JPA Fringe Benefits Consortium SAN DIEGO COUNTY AND IMPERIAL COUNTY SCHOOLS EMPLOYEE NOTICE WORKERS COMPENSATION BENEFITS
JPA Risk Management JPA Fringe Benefits Consortium SAN DIEGO COUNTY AND IMPERIAL COUNTY SCHOOLS EMPLOYEE NOTICE WORKERS COMPENSATION BENEFITS This is to notify you of benefits, available to you through
More informationHealthy Michigan MEMBER HANDBOOK
Healthy Michigan MEMBER HANDBOOK 2014 The new name for Healthy 1 TABLE OF CONTENTS WELCOME TO HARBOR HEALTH PLAN.... 2 Who Is Harbor Health Plan?...3 How Do I Reach Member Services?...3 Is There A Website?....
More informationJanuary 1, 2015 December 31, 2015
BLUESHIELD FOREVER BLUE MEDICARE PPO VALUE AND BLUESHIELD MEDICARE PPO 750 (PPO) (a Medicare Advantage Preferred Provider Organization (PPO) offered by HEALTHNOW NEW YORK INC. with a Medicare contract)
More informationHNE Premier 1 (HMO) and HNE Premier 2 (HMO)
2016 Medicare Advantage Summary of Benefits HNE Premier 1 (HMO) and HNE Premier 2 (HMO) January 1, 2016 - December 31, 2016 H8578_2016_429 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2016 SECTION I
More information2015 Summary of Benefits
2015 Summary of Benefits January 1, 2015 December 31, 2015 Houston/Beaumont Area Y0067_PRE_H4506_SETX_SB41_0814 CMS Accepted 09/13/2014 HMO-SETX-SB K41 2015 Section I Introduction to Summary of Benefits
More informationSTANDARD OPERATING PROCEDURE SOP Sec. 5.4 Workers Compensation Incident Reporting
This SOP implements Section 5.4 of the Policy Manual. A. If an incident occurs in which an employee is injured during the course of and arising out of his/her employment with the County, the employee shall:
More information2015 Medicare Advantage Summary of Benefits
2015 Medicare Advantage Summary of Benefits HNE Medicare Premium No Rx and HNE Medicare Basic No Rx January 1, 2015 - December 31, 2015 H8578_2015_034 Accepted HNE MEDICARE ADVANTAGE ENROLLMENT KIT 2015
More informationWORKPLACE SAFETY Injury/Illness Prevention Program (IIPP)
WORKPLACE SAFETY Injury/Illness Prevention Program (IIPP) Comprehensive Workplace Safety System (CWPSS) The CWPSS is a KP National Labor Management Partnership (LMP) initiative to promote a safe work environment
More informationChimacum School District. Standard Tort Claim Form Packet
Chimacum School District Standard Tort Claim Form Packet Please carefully read all of the information in this packet before completing and presenting your Standard Tort Claim. A New Law that Impacts Presenting
More informationACCIDENT REPORTING PROCEDURE
ACCIDENT REPORTING PROCEDURE 1. Employee must notify supervisor immediately. 2. Employee must complete Workers Compensation form 1A (Employee s First Report of Injury) immediately following the accident
More informationOccupational Medicine
2408 Wanda Daley Drive Ames, Iowa 50011-3602 (515) 294-5359 www.ehs.iastate.edu Copyright Reviewed 2015 Environmental Health and Safety 2809 Daley Drive Ames, IA 50011-3660 Ph: (515) 294-5359 www.ehs.iastate.edu
More informationSCHEDULE OF BENEFITS
SCHEDULE OF BENEFITS Premier HealthOne Bronze 5500 Health Maintenance Organization (HMO) Individual Certificate of Coverage This schedule of benefits (SOB) is part of your Certificate of Coverage (COC)
More information1960 Ogden St. Suite 120, Denver, CO 80218, 303-318-3840
Dear Valued Patient, 1960 Ogden St. Suite 120, Denver, CO 80218, 303-318-3840 Thank you for choosing Denver Medical Associates as your healthcare provider. We strive to provide you with the best possible
More informationSummary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015. HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595
Summary of Benefits JANUARY 1 THROUGH DECEMBER 31, 2015 HealthPlus MedicarePlus Essential HealthPlus MedicarePlus Classic CMS Contract #H1595 For Medicare-eligible beneficiaries residing in Arenac, Bay,
More informationAnnual Notice of Changes for 2015
Keystone 65 Select Medical-Only (HMO) offered by Independence Blue Cross Annual Notice of Changes for 2015 You are currently enrolled as a member of Keystone 65 Select Medical-Only. Next year, there will
More informationJanuary 1, 2016 December 31, 2016. Summary of Benefits. Aetna Medicare Value Plan (HMO) H3312-060 H3312.060.1
January 1, 2016 December 31, 2016 Summary of Benefits H3312-060 H3312.060.1 Y0001_2016_H3312_060 Accepted 9/2015 Summary of Benefits January 1, 2016 December 31, 2016 This booklet gives you a summary of
More informationHow To Write A Workers Compensation Check
WORKERS COMPENSATION Office of Human Resources WHAT IS WORKERS COMPENSATION? Workers Compensation is a University paid benefit for employees and students that are working payroll or work study. Workers
More informationWe re here to change that. Transforming Occupational Medicine, one client at a time. Mission Statement
About Us is a privately owned company established in 1999 by its Founder, President & CEO Dr. Michael J. DeLitta. We believe that caring is the best medicine. This ideal is woven thoughout every aspect
More informationTribute. 2015 Summary of Benefits. Health Plan of Oklahoma. Tribute Health Plan of Oklahoma HMO SNP
Tribute Health Plan of Oklahoma Tribute Health Plan of Oklahoma HMO SNP 2015 Summary of Benefits This booklet gives you a summary of what we cover and what you pay. It doesn t list every service that we
More informationYOUTH CONSULTATION SERVICE (YCS) WORKERS COMPENSATION POLICY AND PROCEDURES
YOUTH CONSULTATION SERVICE (YCS) WORKERS COMPENSATION POLICY AND PROCEDURES - 1 -Revised 02/05 PHILOSOPHY STATEMENT It shall be the philosophy of Youth Consultation Service to value its employees as important
More informationRoanoke College 2015 Wellness Program
Roanoke College 2015 Wellness Program Welcome from bebetter Health, your partner in wellness! We realize that many of you are searching for ways to improve your health, whether it s to exercise more, lose
More information