SEE WHAT'S NEW!
Please take note of our guidance for reporting COVID-19 claims (PDF).
We have created a new email address where you can send all First Reports of Injury (FROI) forms. The address is: firstname.lastname@example.org. We ask that all Departmental Designees begin sending all packets to the new address listed above, rather than continue to send them to individual assistants within Workers' Compensation.
Thank you for your efforts to assist your Department’s supervisors and their employees with their workers’ compensation needs.
Ideally, the employee should file the First Report packet within 24-48 hours of occurrence:
- Employee’s First Report of Injury (MS Word)
- New Vendor form (PDF)
- Medical Release of Information form (PDF)
- Benefit Leave Option form (PDF), For more information regarding the Benefit Leave Option form, please read the new Workers' Compensation policy on coordination of benefits (PDF).
The employee’s supervisor must complete the Supervisor’s Report (MS Word) and submit it to the designee at the time the injury is reported.
Along with the First Report packet, we encourage claims reporting and medical appointment, if appropriate, within 24 to 48 hours after occurrence of injury. A work-related injury must be reported by the employee within 30 days of occurrence.
Medical Appointment Information
- Finding a Provider: In order to provide our employees with the highest quality of care, we use qualified occupational medical professional that can be found on the 10-Day Provider Listing. Please check the listing for a provider near you.
- Mileage: Employees are provided mileage reimbursement for travel to and from approved medical appointments. For specific reimbursement guidelines, please contact us. The current mileage reimbursement rate is reflected on the Mileage Expense Reimbursement Form (PDF).
- Administrative Leave: The employee is afforded Administrative Leave to attend approved workers comp medical appointments. Guidelines can be found in the Administrative Leave Policy.
Please contact us for direction on claims and or to answer any specific questions you may have.