A Workers' Compensation claim is to be completed by employee and supervisor in the event of an on the job injury by the employee. Such claims are to be completed within 24 hours of the injury. This process must be followed even if no medical treatment is immediately needed for the injury.
Instructions for Workers' Compensation Coordinator:
- Follow the instructions above in the "Instructions for Completing Workers' Compensation Claims" document.
- If the employee requires medical treatment, complete the Medical Treatment Authorization form.
- If you do not have a "Medical Treatment Authorization" form on-site, please call or email the HRDC 980-343-4777 (effective 7/1 HRDC phone number will change to 980-343-4732) or firstname.lastname@example.org to request a copy
Instructions for Employee:
- Provide any necessary information to complete the Workers' Comp Claim at your worksite.
- If you require medical treatment, get a completed Medical Treatment Authorization form from your Workers' Compensation Coordinator.
- Notify your supervisor and the Benefits Coordinator of your medical status .