CLAIMS PROCEDURE CHECKLIST
supervisor immediately when an incident, injury or exposure to an
occupational disease occurs in the course and scope of your job.
supervisor or workersí compensation specialist (claims coordinator) at
once if medical services are needed due to a work-related injury or
illness. Do not pay for any medical services.
- If lost time
from work occurs, the employee must inform their supervisor that they are
off work due to a work-related injury. The employee is required to
meet with the claims coordinator to complete an election form as soon as
lost time begins. Do not return to work before clearing with the
claims coordinator. A medical release will be required.
- Complete a Supervisorís
Report of Incident, Injury or Illness.
- If applicable,
have witness complete a Witness Statement. Send the original Witness
Statement to claims coordinator within two work days.
notify the claims coordinator if the employee will need (or has received)
- Fax or provide a
copy of the Supervisorís Report to the claims coordinator within 24 hours.
Sign and send the original report to the departmentís additional duty
safety officer (ADSO) for review and signature.
- Do not allow the
employee to return to work before clearing with the claims coordinator. A
medical release will be required.
Duty Safety Officer (ADSO):
- Complete the
review portion of the supervisorís report and forward to the department
head or account manager.
- Sign and date
the report, then forward original report to the department head or account
Head or Account Manager:
- Notify workersí
compensation specialist (claims coordinator) immediately in case of
a serious injury, an injury or illness resulting in death, or if more than
one employee is injured.
Supervisorís Report, sign, and return the original to the claims
coordinator within seven calendar days of processing the Supervisorís Report.
Maintain a copy of the report in the department files. Provide a copy to
the Environmental Health, Safety & Risk Management Office.