Workers Compensation


    Employee Injury Reporting ProceduresReport of Work Injury Form Image

    Employees: Employees shall report ALL injuries to their immediate supervisor or office manager immediately.  Call Company Nurse - first.

    Principal, Director or Supervisor: If the accident is serious in nature and requires immediate medical attention, the supervisor or office manager should CALL 911 and the Department of Risk Management at 780-4120 and verbally report the accident.  In addition, the supervisor must also….

    • Provide the employee with the entire workers compensation packet.
    • Give employee the Medical Records Release Authorization Form, the Preferred Provider Panel, and the Payroll Option Form. 
    • If emergency medical treatment is needed, the employee may go to the closest emergency room or medical treatment facility. If not an emergency, the employee must call Company Nurse at 1-888-770-0925 and use Code V276B.  Choose a physician from the Preferred Provider Panel for treatment including follow-up visits.
    • Investigate the circumstances which caused the accident, and recommend appropriate corrective measures to eliminate the hazard and prevent future occurrences.
    • Employees should fill out the forms; it is NOT the responsibility of the supervisor or office manager.   In case of emergency, the Supervisor must call Company Nurse to initiate the claim for the employee.
    • Note: The school location must forward all forms to the Office of Risk Management within forty-eight hours of the accident.
    • Do not assume that claims will be paid because the incident occurred at work or during the course of work. Claims must be investigated by the Third Party Administrator (TPA) to determine if the claim is compensable.
    • Employees must provide a valid doctor’s note to their supervisor. It is the responsibility of the supervisor to monitor and ensure that the employee has a valid doctor’s note throughout the duration of the disability and upon the employee’s return to work.
    • Leave time for workers comp should be coded workers comp leave without pay. This is a flag in the payroll system for payroll staff to process.
    • It is the responsibility of the location supervisor and timekeeper to ensure that all leave time is coded appropriately for the employee that is out of work.


    Workers Compensation Forms
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