Workers Compensation. Presented by: Sarah L. Stoker, M.S. Coordinator II, Equal Employment Opportunity & Risk Administration March 27, 2014

Size: px
Start display at page:

Download "Workers Compensation. Presented by: Sarah L. Stoker, M.S. Coordinator II, Equal Employment Opportunity & Risk Administration March 27, 2014"

Transcription

1 Workers Compensation Presented by: Sarah L. Stoker, M.S. Coordinator II, Equal Employment Opportunity & Risk Administration March 27, 2014

2 What is Workers Compensation? Workers Compensation pays medical expenses and helps offset lost wages for employees and volunteers with work-related injuries or illnesses. May apply to health students involved in a clinical experience and visitors.

3 What benefits does Workers Compensation provide? Covers 2/3 of the employee s gross salary after they have missed 3 days of work (Use sick or vacation leave for the 3 days. If you are off more than 14 days, you will be reimbursed for the 3 days.) Hourly employees are off without pay

4 How long do I have to work at Salt Lake Community College (SLCC) before I am protected by Workers Compensation? You are entitled to Workers Compensation benefits for workrelated injuries or illnesses as soon as you begin working at SLCC, even if you work part-time.

5 Who pays for Workers Compensation? SLCC; the cost cannot be deducted from your wages

6 Can my claim be denied because I was at fault for the injury? No. Workers Compensation is a no-fault system.

7 Who is SLCC s Workers Compensation insurance carrier? Workers Compensation Fund 100 S Towne Ridge Pkwy Sandy, UT (385)

8 Reporting an Injury

9 Who do I report a work-related injury or illness to? Notify your supervisor immediately; it is their responsibility to report the injury or illness to EEO & Risk Administration by the next working day. Sarah Stoker Mikel Birch (801) (801) sarah.stoker@slcc.edu mikel.birch@slcc.edu

10 When reporting, it s helpful, but not required to know the following: Name of Injured Employee Phone Number of Injured Employee Date and Time of Injury Summary of Injury Actions Taken Witnesses Conditions of Accident/Apparent hazards

11 Report of Injury/ SLCC Incident Form SALT LAKE COMMUNITY COLLEGE INCIDENT FORM SLCC OFFICE OF RISK MANAGEMENT Name (Last, First, Middle) Student Number Telephone Day: Evening: Address Parent or Responsible Guardian: Name of individual notified: Injured person left scene of injury by : He/She was released to: Date: Date: DOB/Age Sex Female Classification/Status Male Student Faculty Staff Visitor Other Date and Time of Incident Severity Non disabling (loss of less than one full day of normal activity) Disabling (loss of one or more full days of normal activity) Jurisdiction On college property or in college conducted activity SLCC Campus: Off campus in non college conducted activity ACTIVITY AT THE TIME OF THE ACCIDENT/EXPOSURE: (i.e.driving auto, transporting items, etc. ) DETAILS OF ACCIDENT/INCIDENT: (Describe in full the events, conditions and factors that contributed to the incident) TYPE OF ACTIVITY: Athletic or physical education Recreation or entertainment Instruction Exterior walk or sidewalk Other, specify Street or highway Commerce or industry Service or maintenance Undeveloped area PART OF BODY INJURED: Emergency care & individual status: First Aid Injured party refused treatment WITNESSESS: (Name, Address, Phone Numbers) Individual referred to hospital/medical facility for evaluation. LOCATION: (Bldg Rm No. be specific) NATURE OF INJURY: Cut Puncture Poisoning Inhalation Open Wound Burn, Bruise Exposure Internal Injury Other (explain) Foreign Body Police Contacted: Yes / No Office of Risk Management Contacted: Yes / No Time Called: Date: Instructions given: Action to prevent similar incidents: This report prepared by: Title & Signature: Address: Date: Please fill out form, sign and return to the following: Original: Office of RiskManagement Copy: Injured Party Copy: Department Office of Risk Management October 2009

12 Medical Attention

13 Where do I go for medical attention? Intermountain Healthcare WorkMed 1685 W S. 201 E S. #100 SLC, UT Murray, UT M-F 7:30 AM 5:30 PM M-F 8 AM 5 PM

14 Where do I go for medical attention? During evening/night/weekend hours, if possible, wait until Intermountain WorkMed is open; otherwise, go to a listed Workers Compensation Preferred Provider ( Go to the Emergency Room only for threat of life or limb.

15 What if I have a Blood Borne Injury? Follow the protocol at the facility where you were injured; if the facility does not have a protocol go to: University of Utah Infectious Diseases University Hospital Clinic 1A 50 North Medical Drive Salt Lake City, UT M-F 8 AM 5 PM, call for an appointment

16 Can my employer or its insurance company require me to go to a specific doctor or hospital for treatment? Only for the first visit.

17 Filing a Claim

18 How do I File a Workers Compensation Claim? When EEO & Risk Administration is notified of an injury, we will schedule a time to meet with the employee to file the claim on-line. Filing typically takes about 30 minutes. Claims should be reported to Workers Compensation with-in 7 days after the injury or illness (12-hours for serious injury or illness).

19 Returning to Work

20 When can I return to work? You can return to work when you are able to do so. You should consult with your Physician to obtain a Full-Duty Work Release or a Temporary or Transitional Work Assignment.

21 What is a Temporary or Transitional Work Assignment? Temporary assignment that restricts the employee s activity as per doctor's orders It has a beginning date and an ending date Signed off by the employee, the employee's supervisor and the Transitional Work Coordinator (Sarah Stoker) Must use sick, vacation, or no pay for doctor appointments that are scheduled during the work day, unless appointments cannot be scheduled at any other time.

22 Questions???

Injury Illness Response and Reporting Procedure

Injury Illness Response and Reporting Procedure Injury Illness Response and Reporting Procedure Policy: The following is the procedure for reporting and response to injuries or illnesses for employees, students, official volunteers and/or visitors at

More information

Employee s Report of Work-Related Injury University of Maryland, College Park

Employee s Report of Work-Related Injury University of Maryland, College Park Employee s Report of Work-Related Injury To be completed immediately after the accident or initial treatment and submitted to your supervisor Employee Name: UID: Male (First) (Last) Female Date of Birth:

More information

Workers Compensation Injury/Illness Reporting

Workers Compensation Injury/Illness Reporting Workers Compensation Injury/Illness Reporting s I. Introductions/Objectives This document outlines the procedures and responsibilities for reporting injuries, illnesses, accidents and medical emergencies

More information

#6-604 Accident Reporting Policy Page 1 of 5

#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 information

Worker s Compensation and Incident Reporting for Supervisors

Worker s Compensation and Incident Reporting for Supervisors Worker s Compensation and Incident Reporting for Supervisors This training session will help you to understand who is covered, how to report an accident, what the deadlines are for reporting, and what

More information

Employee Injury/Illness Reporting and Managed Return to Work. April 15, 2011 HR 23. Human Resources Responsible Key Business

Employee Injury/Illness Reporting and Managed Return to Work. April 15, 2011 HR 23. Human Resources Responsible Key Business Managed Return to Work Date Effective April 15, 2011 City Manager Revision Date Effective Code Number HR 23 Human Resources Responsible Key Business Objective: The City of Charlotte seeks to ensure the

More information

A Transitional Work Program benefits employees in several ways:

A Transitional Work Program benefits employees in several ways: Workmen s Compensation Policy Number: 7390 Effective Date: All employees of Snake River School District 52 are covered by Workmen's Compensation insurance for bodily injury, disease, or death caused by

More information

Work-Related Injuries and Illnesses Advisory What you need to know

Work-Related Injuries and Illnesses Advisory What you need to know Work-Related Injuries and Illnesses Advisory What you need to know Components of the Advisory a.) Medical treatment b.) Incident Reporting c.) Time off and returning to work d.) Filing Workers Compensation

More information

Injured Employee Workers Compensation Guidelines To be followed by the injured or ill employee

Injured Employee Workers Compensation Guidelines To be followed by the injured or ill employee Injured Employee Workers Compensation Guidelines To be followed by the injured or ill employee Name of Employee: Date of Work Related Injury or Illness: Description of Injury or Illness: Location Where

More information

Delaware State University

Delaware State University Delaware State University University Responsible Unit: Risk and Safety Management; Office of Human Resources Policy Number and Name: 7-12 Worker s Compensation Policy Approval Date: April 13, 2015 Next

More information

Workers Compensation. Your Guide to Handling Worker s Compensation Reporting and Filing

Workers 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 information

5.42.2 Designated Workers Compensation Facilities

5.42.2 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 information

LEAVES CITY OF PORTLAND HUMAN RESOURCES ADMINISTRATIVE RULES 6.13 SUPPLEMENTAL WORKERS COMPENSATION BENEFITS

LEAVES CITY OF PORTLAND HUMAN RESOURCES ADMINISTRATIVE RULES 6.13 SUPPLEMENTAL WORKERS COMPENSATION BENEFITS CITY OF PORTLAND HUMAN RESOURCES ADMINISTRATIVE RULES LEAVES Purpose The purpose of this Administrative Rule is to provide additional benefits to eligible employees with accepted workers compensation claims.

More information

Workers Compensation Program Review and Approval Authority

Workers Compensation Program Review and Approval Authority July 2003 Workers Compensation Program Review and Approval Authority Prepared and Edited by: Assistant Director Date UM Workers Compensation Manager Date Reviewed and Approved by: Chair - UM E, H & S Operations

More information

How To File A Worker S Compensation Claim In Azoria

How To File A Worker S Compensation Claim In Azoria Workers Compensation Instructions for Filing a Claim Please complete following steps within 24 48 hours of the incident: Report the incident to your supervisor immediately or, if a medical emergency, dial

More information

presented by the Personnel Services Department of Human Resources

presented by the Personnel Services Department of Human Resources Workers Compensation Training for Supervisors presented by the Personnel Services Department of Human Resources Workers Compensation What is workers compensation? Who is covered? Employee & Supervisor

More information

Workers Compensation

Workers 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 information

Workers Compensation Procedures Booklet

Workers Compensation Procedures Booklet Workers Compensation Procedures Booklet Supervisor Use TABLE OF CONTENTS WHAT IS WORKERS' COMPENSATION?... 3 WHO IS COVERED?... 3 WHAT SHOULD I DO WHEN AN EMPLOYEE IS INJURED OR CONTRACTS AN OCCUPATIONAL

More information

For the purpose of this Procedure the following definitions will apply:

For the purpose of this Procedure the following definitions will apply: Procedure 6.5: Workplace Safety and Injury Reporting Volume 6 Managing Office: Office of Human Resources Effective Date: March 15, 2011 Revised: June 2014 I. GENERAL POLICY Alabama A&M University ( AAMU

More information

WORKERS COMPENSATION POLICY

WORKERS COMPENSATION POLICY Revised: 08/03/06 THE CITY OF POMONA SAFETY POLICIES AND PROCEDURES WORKERS COMPENSATION POLICY City Manager: I. PURPOSE This Policy describes the procedures for the City of Pomona s self-insured workers

More information

ASU SUPERVISOR S ACCIDENT/ILLNESS INVESTIGATION FORM

ASU SUPERVISOR S ACCIDENT/ILLNESS INVESTIGATION FORM ASU SUPERVISOR S ACCIDENT/ILLNESS INVESTIGATION FORM Return to: ASU Office of Human Resources, Workers Comp Office, PO Box 32010, Human Resources Building, 330 University Hall Drive, Boone, NC 28608 This

More information

University Policy Number 200.23 POLICY ON WORKERS COMPENSATION

University Policy Number 200.23 POLICY ON WORKERS COMPENSATION University Policy Number 200.23 POLICY ON WORKERS COMPENSATION Responsible Administrator: Executive Vice President Responsible Office: Office of Human Resources Originally Issued: March 2009 Revision Date:

More information

ACCIDENT / INJURY REPORTING PROCEDURES FOR GEORGIA STATE UNIVERSITY

ACCIDENT / 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 information

STANISLAUS COUNTY OFFICE OF EDUCATION. Safety Department. Employee Workers Compensation Manual

STANISLAUS COUNTY OFFICE OF EDUCATION. Safety Department. Employee Workers Compensation Manual STANISLAUS COUNTY OFFICE OF EDUCATION Safety Department Employee Workers Compensation Manual T A B L E O F C O N T E N T S S E P T E M B E R 2 0 1 4 Introduction 3 Workers Compensation Defined 3 Workers

More information

(This is a sample of the injury packet that GENEX will customize for each employer)

(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 information

Princeton University Work-Related Injury Management Frequently Asked Questions for Supervisors

Princeton University Work-Related Injury Management Frequently Asked Questions for Supervisors Princeton University Work-Related Injury Management Frequently Asked Questions for Supervisors Section 1: Short-Term Disability and Workers Compensation... 2 Section 2: Reporting Injuries and Seeking Medical

More information

How To Get Paid For An Accident On The Job In South Carolina

How 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 information

Delaware State University

Delaware State University Delaware State University University Area Responsible: Risk and Safety Management; Office of Human Resources Policy Number and Name: 7-12: Worker s Compensation Policy Approval Date: 7/28/11 Revisions:

More information

Who Administers the Workers Compensation Program and Related Responsibilities?

Who Administers the Workers Compensation Program and Related Responsibilities? What is Workers Compensation? Who Administers the Workers Compensation Program and Related Responsibilities? Who is Eligible for Workers Compensation? What Coverage is Provided? What is a Compensable Injury?

More information

WORKERS' COMPENSATION CLAIMANT INFORMATION PACKET

WORKERS' COMPENSATION CLAIMANT INFORMATION PACKET WORKERS' COMPENSATION CLAIMANT INFORMATION PACKET Instructions Statement of Rights Prescription ID and Pharmacy Information The New York State Insurance Fund TLC EMERGENCY MEDICAL SERVICES Inc. TLC MEDICAL

More information

Accident/Incident & Workers Compensation. Packet

Accident/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 information

TEXAS DEPARTMENT OF CRIMINAL JUSTICE Supervisor s Report Packet for Workers Compensation CONTENTS

TEXAS DEPARTMENT OF CRIMINAL JUSTICE Supervisor s Report Packet for Workers Compensation CONTENTS Supervisor s Report Packet for Workers Compensation CONTENTS PERS 299-1, Supervisor s Guidelines for Workers Compensation PERS 299-2, Witness Statement PERS 299-3, Supplemental Worksheet PERS 299 (09/15)

More information

UNIVERSITY SYSTEM OF MARYLAND

UNIVERSITY SYSTEM OF MARYLAND UNIVERSITY SYSTEM OF MARYLAND II-2.32 POLICY ON ACCIDENT LEAVE FOR FACULTY (Approved by the Board of Regents, June 21, 2013) I. PURPOSE AND SCOPE This policy governs Accident Leave for Faculty in compliance

More information

RUTGERS POLICY. Errors or Changes? Contact: Department of Risk Management and Insurance, 848-932-3005

RUTGERS POLICY. Errors or Changes? Contact: Department of Risk Management and Insurance, 848-932-3005 RUTGERS POLICY Section: 40.3.1 Section Title: Risk Management & Insurance Policy Name: Risk Management and Insurance Policies Formerly Book: 5.3.1 Approval Authority: Senior Vice President for Finance

More information

ACCIDENT, INJURY, AND INCIDENT REPORTING PROCEDURES

ACCIDENT, INJURY, AND INCIDENT REPORTING PROCEDURES ACCIDENT, INJURY, AND INCIDENT REPORTING PROCEDURES VEHICLE ACCIDENTS/PROPERTY DAMAGE Non-Workers Compensation Accident Report Form Attached is a sample copy of the accident report for vehicle damage,

More information

POLICY & PROCEDURE DOCUMENT NUMBER: 4.9102. Finance and Administration. Workers Compensation Program. DATE: February 6, 2006

POLICY & PROCEDURE DOCUMENT NUMBER: 4.9102. Finance and Administration. Workers Compensation Program. DATE: February 6, 2006 POLICY & PROCEDURE DOCUMENT NUMBER: 4.9102 DIVISION: TITLE: Finance and Administration Workers Compensation Program DATE: February 6, 2006 REVISED: December 10, 2007, March 15, 2014 Policy for: All Employees

More information

What s New With CSU Workers Compensation & Workers Compensation Basics. Kenda Weigang November 2015

What s New With CSU Workers Compensation & Workers Compensation Basics. Kenda Weigang November 2015 What s New With CSU Workers Compensation & Workers Compensation Basics Kenda Weigang November 2015 Updated Website & WC Process Risk Management has a new website http://rmi.prep.colostate.edu/ Workers

More information

STUDENT ACCIDENT CLAIMS

STUDENT ACCIDENT CLAIMS STUDENT ACCIDENT CLAIMS When a student (see instructions for the work-study program at the bottom of the page) has an accident on campus, the student should be given the attached Student Accident paperwork.

More information

2. Employees will receive regular pay for the hours scheduled on the day of injury.

2. Employees will receive regular pay for the hours scheduled on the day of injury. SECTION 10.5 WORKERS COMPENSATION POLICY A. Statement of Purpose Jefferson County provides Workers' Compensation benefits for injuries or illnesses sustained in the course and scope of employment in accordance

More information

THE SUPERVISOR S ROLE:

THE 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 information

Accident/Illness Claim

Accident/Illness Claim QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Accident/Illness Claim The issue of this form does not constitute an admission of liability on the part of the insurer. Please complete all sections.

More information

EMPLOYEE INJURY REPORTING PROCEDURE

EMPLOYEE INJURY REPORTING PROCEDURE Updated 8/1/2014 TDY MEDICAL STAFFING, Inc. EMPLOYEE INJURY REPORTING PROCEDURE STEP 1: IS INJURY LIFE THREATENING/EMERGENCY? Call 911/go to ER if yes. STEP 2: CALL CLAIM INTO TDY 215-736-5147 STEP 3:

More information

The Worker s Compensation Process

The Worker s Compensation Process Workers Compensation Basics The Worker s Compensation Process Kenda Weigang MARCH 2015 What should be posted Workers Compensation ACT Notice to Employees Authorized Treating Physician (ATP) Notification

More information

Office of Human Resources Standard Operating Procedure HR SOP #021

Office of Human Resources Standard Operating Procedure HR SOP #021 Office of Human Resources Standard Operating Procedure HR SOP #021 Subject: Workers Compensation Effective Date: April 1, 2014 Policy Statement: The Department of Natural Resources (DNR) will coordinate

More information

Introduction...2. Or Occupational Disease...3. Workers Compensation Benefits...5. Prescription Processing Services...6. Payroll Procedures...

Introduction...2. Or Occupational Disease...3. Workers Compensation Benefits...5. Prescription Processing Services...6. Payroll Procedures... Table Of Contents Introduction...2 Procedures For Reporting A Work-Related Injury Or Occupational Disease...3 Workers Compensation Benefits...5 Prescription Processing Services...6 Payroll Procedures...6

More information

NT WORKERS COMPENSATION CLAIM FORM

NT WORKERS COMPENSATION CLAIM FORM Information for Workers Guidance to PART 1 of the Claim Form Notify your employer of your injury, verbally or in writing, as soon as practicable. Fully complete PART 1 (questions 1 to 8) of the following

More information

WORKERS COMPENSATION GUIDELINES Reporting and Processing Workers Compensation Claims

WORKERS COMPENSATION GUIDELINES Reporting and Processing Workers Compensation Claims WORKERS COMPENSATION GUIDELINES Reporting and Processing Workers Compensation Claims In the following pages you will find frequently asked questions and answers regarding the reporting and processing of

More information

WORKER S COMPENSATION, ACCIDENT REPORTING AND OSHA RECORDKEEPING

WORKER S COMPENSATION, ACCIDENT REPORTING AND OSHA RECORDKEEPING Authority: WORKER S COMPENSATION, ACCIDENT REPORTING AND OSHA RECORDKEEPING Chancellor History: Revised January 22, 2007; supersedes former Policy No. HR 5.10 effective July 24, 1995 Source of Authority:

More information

Workers Compensation Claim Form (DWC 1) & Notice of Potential Eligibility e3301 (rev. 01/12) DWC 1 (rev. 6/10)

Workers Compensation Claim Form (DWC 1) & Notice of Potential Eligibility e3301 (rev. 01/12) DWC 1 (rev. 6/10) Workers' Compensation Claim Kit Instructions for Completing the Forms Required to Report a Work-Related Injury or Illness California Department of Human Resources Workers Compensation Program What are

More information

Purpose of the Policy Who Needs to Know This Policy The University s Obligations Supervisor/Human Resources Officers Obligations

Purpose of the Policy Who Needs to Know This Policy The University s Obligations Supervisor/Human Resources Officers Obligations New York University University Policy Title: Workers Compensation Policy and Procedure Effective Date: 01/01/2011 Last Revised: 03/07/2013 Issuing Authority: Office of the Executive Vice President Responsible

More information

Workers' Compensation CLAIMS KIT

Workers' 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 information

Workers Compensation Policy and Procedure

Workers Compensation Policy and Procedure EL PASO COUNTY DEPARTMENT OF HUMAN RESOURCES Workers Compensation Policy and Procedure Revised Date: March 21, 2016 I. Purpose The County of El Paso provides workers compensation benefits for incidental

More information

Occupational Injury / Illness Report

Occupational 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 information

Workers Compensation Informational Materials and Filing Overview

Workers Compensation Informational Materials and Filing Overview Workers Compensation Informational Materials and Filing Overview Call 911, as applicable, and/or seek medical attention as necessary. Report the incident to the supervisor/department. The supervisor/department

More information

EMPLOYER INJURY CLAIM REPORT

EMPLOYER INJURY CLAIM REPORT EMPLOYER INJURY CLAIM REPORT FOR HELP COMPLETING THIS FORM OR FOR MORE INFORMATION CONTACT: Your WorkSafe Victoria (WorkSafe) Agent The WorkSafe Advisory Service: freecall 1800 136 089 or (03) 9641 1444

More information

If you have suffered a work-related injury or illness, you should read this memo and follow the guidelines provided below:

If you have suffered a work-related injury or illness, you should read this memo and follow the guidelines provided below: Telephone: (808) 956-3100 Fax (808) 956-5022 The Research Corporation of the University of Hawaii Human Resources Office First issued: 06/27/2002 Revised: 09/25/2008, 08/26/2013 MEMORANDUM TO: FROM: SUBJECT:

More information

Accident/Illness Claim

Accident/Illness Claim QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Accident/Illness Claim The issue of this form does not constitute an admission of liability on the part of the insurer. Please complete all sections

More information

Workers Compensation Procedure

Workers Compensation Procedure City and County of Denver Workers Compensation Procedure Issued September 10, 2001 Revised 2/1/2013 Workplace Safety 201 West Colfax Avenue Dept. 1105 Denver, CO 80202 Risk.Management@Denvergov.org Workplace

More information

Model Safety Program. Construction CORPORATE HEADQUARTERS 518 EAST BROAD STREET COLUMBUS, OHIO 43215 614.464.5000 STATEAUTO.COM

Model Safety Program. Construction CORPORATE HEADQUARTERS 518 EAST BROAD STREET COLUMBUS, OHIO 43215 614.464.5000 STATEAUTO.COM TM Model Safety Program Construction CORPORATE HEADQUARTERS 518 EAST BROAD STREET COLUMBUS, OHIO 43215 614.464.5000 STATEAUTO.COM TM Disclaimer: The information contained in this publication was obtained

More information

Madison County Board Of Education

Madison County Board Of Education JOB-RELATED INJURY INSTRUCTIONS In compliance with Board Policy FILE: 5.9.4, Absences Due to Job-Related Injuries, the following instructions must be followed when injuries occur on the job. Please read

More information

PETITIONER STATES AS FOLLOWS:

PETITIONER STATES AS FOLLOWS: State of Utah Labor Commission Division of Adjudication 160 East 300 South, 3 rd Floor, P.O. Box 146615 Salt Lake City, Utah 84114 6615 (801) 530 6800 casefiling@utah.gov Note: PLEASE TYPE OR PRINT CLEARLY

More information

North Carolina State Government

North Carolina State Government North Carolina State Government W O R K E R S C O M P E N S A T I O N E M P L O Y E E H A N D B O O K PURPOSE The contents in this handbook are designed to provide employees of the State of North Carolina

More information

HANOVER COUNTY PUBLIC SCHOOLS

HANOVER 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 information

1. The initial claim must be filed within 20 days of employees last work day.

1. The initial claim must be filed within 20 days of employees last work day. DISABILITY LEAVE SOURCE: OHIO REVISED CODE 124.385, OHIO ADMINISTRATIVE CODE 123:1-33-07, & OCSEA/AFSCME BARGAINING UNIT AGREEMENT ARTICLE 35 CONTACT: OFFICE OF EMPLOYEE SERVICES Disability Leave Policy:

More information

CLAIMS 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 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 information

FORM 1 PERSONAL INJURIES PROCEEDINGS ACT 2002. NOTICE OF CLAIM (Non-Health Care Claims)

FORM 1 PERSONAL INJURIES PROCEEDINGS ACT 2002. NOTICE OF CLAIM (Non-Health Care Claims) FORM 1 PERSONAL INJURIES PROCEEDINGS ACT 2002 NOTICE OF CLAIM (Non-Health Care Claims) INSTRUCTIONS FOR COMPLETING THIS FORM ARE ATTACHED AS THE LAST THREE PAGES OF THE FORM PLEASE READ INSTRUCTIONS CAREFULLY

More information

How To Write A Workers Compensation Check

How 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 information

UNIVERSITY OF NORTH DAKOTA WORKERS COMPENSATION PROCESS 5/28/2014 Process Employees Supervisor Safety/Claims Management Emergency Incident requires

UNIVERSITY OF NORTH DAKOTA WORKERS COMPENSATION PROCESS 5/28/2014 Process Employees Supervisor Safety/Claims Management Emergency Incident requires Emergency Incident requires medical attention Medical needed, not an emergency Designated Medical Provider(DMP) Guidelines If the injury is an emergency, inform your supervisor and report to an emergency

More information

Accumulated Paid Leave: Includes FLSA compensatory time, sick leave, deferred holiday time, annual leave and state compensatory time.

Accumulated Paid Leave: Includes FLSA compensatory time, sick leave, deferred holiday time, annual leave and state compensatory time. GEORGIA DEPARTMENT OF JUVENILE JUSTICE Applicability: {x} All DJJ Staff {x} Administration {x} Community Services {x} Secure Facilities (RYDC s and YDC s) Chapter 3: PERSONNEL Subject: WORKERS COMPENSATION

More information

Federal Employees Compensation Act FAQS for Supervisors. 1. What should you do if you are a supervisor of an injured employee?

Federal Employees Compensation Act FAQS for Supervisors. 1. What should you do if you are a supervisor of an injured employee? Federal Employees Compensation Act FAQS for Supervisors 1. What should you do if you are a supervisor of an injured employee? When an Appropriated Fund employee is injured as a result of work, ensure the

More information

Who It Covers All UCLA employees and registered volunteers are covered for Workers' Compensation.

Who It Covers All UCLA employees and registered volunteers are covered for Workers' Compensation. FACTS ABOUT WORKERS COMPENSATION What Is It Since 1913, California Workers' Compensation law has guaranteed prompt, automatic benefits to workers who become injured or ill because of their jobs. It is

More information

Workers Compensation Claims Report

Workers Compensation Claims Report Workers Compensation Claims Report Tel: (866) 402-6600 Fax: (866) 402-6601 In life-threatening situations, immediately seek medical assistance, then complete this claim form! All work-related incidents

More information

Public Sector Injury Benefit Scheme 2015

Public Sector Injury Benefit Scheme 2015 Public Sector Injury Benefit Scheme 2015 Application for Injury Benefit - Notes for Guidance Purpose of this Guidance Isle of Man Government employers and Injury benefit applicants must read the guidance

More information

Accident/Illness Claim

Accident/Illness Claim QBE INSURANCE (AUSTRALIA) LIMITED ABN 78 003 191 035 Accident/Illness Claim The issue of this form does not constitute an admission of liability on the part of the insurer. Please complete all sections.

More information

WORKER'S COMPENSATION PEMBERTON TOWNSHIP SCHOOLS FIRST REPORT EMPLOYEE INJURY/TREATMENT FORM

WORKER'S COMPENSATION PEMBERTON TOWNSHIP SCHOOLS FIRST REPORT EMPLOYEE INJURY/TREATMENT FORM WORKER'S COMPENSATION PEMBERTON TOWNSHIP SCHOOLS FIRST REPORT EMPLOYEE INJURY/TREATMENT FORM Per District Policy 8440, all work related injuries must be reported to the Nurse or Jim Flanagan (609) 893-8141

More information

For Employees: Employees: What What to to do do when when an an accident occurs 08/19/14/dmv

For Employees: Employees: What What to to do do when when an an accident occurs 08/19/14/dmv For Employees: What to do when an accident occurs 08/19/14/dmv When there is a work-related accident or illness, procedures must be taken to ensure the employees needs are met with respect to treatment

More information

WORKERS COMPENSATION EMPLOYEE S NOTICE OF INJURY (COMPLETE ALL ITEMS)

WORKERS COMPENSATION EMPLOYEE S NOTICE OF INJURY (COMPLETE ALL ITEMS) WORKERS COMPENSATION EMPLOYEE S NOTICE OF INJURY (COMPLETE ALL ITEMS) EMPLOYEE S NAME: (last) (first) EMPLOYEE S ADDRESS: (no.) (street) (city) (state) (zip) TELEPHONE: Home: Work: SOCIAL SECURITY NO.

More information

FACTS ABOUT WORKERS COMPENSATION

FACTS ABOUT WORKERS COMPENSATION FACTS ABOUT WORKERS COMPENSATION What Is It Since 1913, California Workers' Compensation law has guaranteed prompt, automatic benefits to workers who become injured or ill because of their jobs. It is

More information

Workers Compensation Procedures

Workers Compensation Procedures Who qualifies for Workers Comp? Workers Compensation Procedures Any UVU employee, including student employees or volunteers. Unpaid interns placed by academic departments, on and off campus. What do I

More information

OSHA & Workers Compensation Requirements Recording Workplace Injuries & Illness

OSHA & 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 information

Workers Compensation 101. Laura Romaine WC Claims Program Consultant laura.romaine@tasb.org (800)482-7276 ext. 8406

Workers Compensation 101. Laura Romaine WC Claims Program Consultant laura.romaine@tasb.org (800)482-7276 ext. 8406 Workers Compensation 101 Laura Romaine WC Claims Program Consultant laura.romaine@tasb.org (800)482-7276 ext. 8406 Today s Objective Employer Responsibilities in WC Posting and Reporting State Required

More information

Workers Compensation Claims Reporting. What do I do after a Workers Compensation accident occurs?

Workers Compensation Claims Reporting. What do I do after a Workers Compensation accident occurs? Workers Compensation Claims Reporting What do I do after a Workers Compensation accident occurs? Secure medical treatment for your injured employee. If during normal business hours, use an Occupational

More information

Employee Guidelines for Workers Compensation Accidents

Employee 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 information

Date of Birth: / / Male Female Martial Status: Language: English Spanish Other: E-mail: Occupation: Date Hired: / /

Date of Birth: / / Male Female Martial Status: Language: English Spanish Other: E-mail: Occupation: Date Hired: / / Early reporting can save you money. Report all injuries immediately! The information below allows Pinnacol Assurance s customer service representatives to quickly and accurately process your claim. Use

More information

Accident/Injury Reporting and Investigation

Accident/Injury Reporting and Investigation Accident/Injury Reporting and Investigation Purpose and Scope: This program establishes the requirements for the reporting and reviewing of accidents/injuries at Stephen F. Austin State University. It

More information

FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM

FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM APPLICABILITY/ACCOUNTABILITY: In compliance with statutory requirement, this program provides general guidelines for employees who

More information

Employer Responsibilities for On the Job Injuries. Laura Romaine WC Program Consultant TASB Risk Management Fund

Employer Responsibilities for On the Job Injuries. Laura Romaine WC Program Consultant TASB Risk Management Fund Employer Responsibilities for On the Job Injuries Laura Romaine WC Program Consultant TASB Risk Management Fund This information is provided for educational purposes only to facilitate a general understanding

More information

1. Employee Benefits: Workers' Compensation provides both medical and indemnity benefit payments for and to eligible employees.

1. Employee Benefits: Workers' Compensation provides both medical and indemnity benefit payments for and to eligible employees. Policies of the University of North Texas Health Science Center 05.803 Worker s Compensation Insurance Chapter 05 Human Resources Policy Statement. The University of North Texas Health Science Center at

More information

Office of Physical Plant

Office of Physical Plant Office of Physical Plant The Pennsylvania State University Physical Plant Building University Park, PA 16802-1118 Please have the employee complete this Workers Compensation Signature Packet as soon as

More information

Short-Term Disability Program

Short-Term Disability Program Short-Term Disability Program April 1, 2015 THE CBS SHORT-TERM DISABILITY (STD) PROGRAM The CBS Short -Term Disability (STD) Program is a salary continuance program designed to provide eligible employees

More information

NSU Employee Manual. Workers Compensation System Guide

NSU Employee Manual. Workers Compensation System Guide Workers Compensation System Guide 1 NSU Employee Manual For more information regarding prevention of risk visit our website at http://www.nova.edu/cwis/fop/risk/ Table of Contents Florida Guidelines -

More information

7-48 (a) PERSONNEL COMPENSATION REGULATION. 7-48 Workers' Compensation. A. Purpose

7-48 (a) PERSONNEL COMPENSATION REGULATION. 7-48 Workers' Compensation. A. Purpose (a) 7-48 Workers' Compensation A. Purpose 1. The purpose of the Virginia Workers' Compensation Act is to provide compensation to employees for the loss of their opportunity to engage in work when their

More information

We thank you for your business, and look forward to providing you with the necessary protection and care for your business and employees.

We 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 information

THREE RIVERS COMMUNITY COLLEGE PERSONNEL REGULATION

THREE RIVERS COMMUNITY COLLEGE PERSONNEL REGULATION Last Revision: 03/30/10 Page 1 of 7 Workers Compensation The purpose of this regulation is to ensure that employees of Three Rivers Community College injured within the course and scope of their employment

More information

Benefits. Mary S. Kohnke Wagner, Esq. Marshall, Dennehey, Warner, Coleman & Goggin. The following sections explain each element.

Benefits. Mary S. Kohnke Wagner, Esq. Marshall, Dennehey, Warner, Coleman & Goggin. The following sections explain each element. 5 Mary S. Kohnke Wagner, Esq. Marshall, Dennehey, Warner, Coleman & Goggin General Purpose of the Pennsylvania Workers Compensation Act The Pennsylvania Legislature enacted the Pennsylvania Workers Compensation

More information

Controlling WWWWoer Workers Compensation Claims

Controlling WWWWoer Workers Compensation Claims Premiums paid here, stay here to keep Wisconsin strong. Controlling WWWWoer Workers Compensation Claims Presented By: Sheila K. McGraw Director of Claims To The: Wisconsin Towns Associations Annual Convention

More information

Employee s Report of Injury Form

Employee s Report of Injury Form Employee s Report of Injury Form Instructions: Employees shall use this form to report all work related injuries, illnesses, or near miss events (which could have caused an injury or illness) no matter

More information

GENERAL BACKGROUND INFORMATION

GENERAL BACKGROUND INFORMATION Internal Office Use Staff member initials for interview: Date of Incident : Statute of Limitations: Potential Defendants: CLIENT INTAKE FORM Please take the time to answer the questions below as accurately

More information

HUMAN RESOURCES MANAGEMENT POLICY WORKERS COMPENSATION. Policy 27

HUMAN 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 information

HUMAN RESOURCES POLICY Fauquier County, Virginia

HUMAN RESOURCES POLICY Fauquier County, Virginia HUMAN RESOURCES POLICY Fauquier County, Virginia Policy Title: Workers Compensation Effective Date: 05/17/04 36 Supersedes Policy: 09/04/90 I. PURPOSE It is the objective of the Board of Supervisors that

More information