- Immediately report job-related injury or illness to supervisor and seek appropriate medical care..
- Request and complete Employee's Claim for Workers' Compensation Benefits (DWC Form 1).
- Arrange for appropriate medical care.
- Complete required forms:
- Employee's Claim for Workers' Compensation Benefits (DWC Form 1).
- Supervisor's Injury Prevention Report (STD. 620).
- Fax both forms to Human Resources within 24 hours of knowledge of injury
- Notify employee about Return-to-Work Program, maintain contact and encourage early return to work.
- Notify Human Resources and departmental attendance clerk when employee misses work or returns to work.
- Complete Employer's Report for Occupational Injury or Illness (Form 5020) and send to the Third Party Administrator (TPA), along with copy of DWC Form 1 and STD 620.
- Send copies of STD. 620 and DWC Form 1 to Environmental Health and Safety officer.
- Return copy of DWC Form 1 to employee along with a copy of "Facts for Injured Workers."
- Send copy of Supervisor's Injury Prevention Report (STD 620) to supervisor.
- Establish and maintain regular contact with TPA claims adjustor regarding status of claims.
- Provide TPA with all documentation they may require to process claims. These include but are not limited to: first injury reports, doctor's statements, return to work statements, job descriptions, etc.
|Environmental Health and Safety Officer
- Investigate injury/illness if warranted, and report finding to department management and Human Resources.
|Third Party Administrator (TPA)
- Conduct further investigation to determine if work related.
- Approve/deny claim.
- Establish and maintain regular contact with Human Resources staff to process claims, IDL notifications and other responsibilities necessary to providing a comprehensive workers' compensation program.