WORKERS' COMP FORMS
Employee Notification of Rights Materials
What should you do if you are injured on the job?
Report your work injury to your supervisor as soon as possible. Not reporting your injury in a timely manner can delay your claim and treatment.
Call Company Nurse® Injury Hotline at 1-877-518-6702 to report your injury or incident.
Complete the Employee Incident Report of Occupational Injury form as soon as possible after the injury or incident. Return the form to your Administrator, Supervisor, Office Manager or the Human Resources Department.
Read the Employee Workers' Compensation Procedures/Employee Rights Memo and all additional information provided to you.
Seek medical treatment at preferred medical facility, if referred by Company Nurse® You will need to bring your work status from the treating physician or facility to the Human Resources Department to complete any additional required paperwork. It is your responsibility to provide the Human Resources Department with written verification regarding the status of your industrial injury if you seek medical treatment not the treating medical facility or physician. The Human Resources Department must authorize your return to work following any injury and after each follow up appointment until you are discharged from care. This includes all employees released to return to work with/without restrictions or first-aid only cases
Complete the assigned online safety training class(es) through Keenan SafeSchools as assigned by the Human Resources Department.
Important Rx Information:
If your treating physician or facility prescribes medication for your injury, you must fill any prescription(s) through Express Scripts® using the PRIME Rx Card at a participating pharmacy. DO NOT FILL A PRESCRIPTION THROUGH ANY OTHER PHARMACY INCLUDING KAISER.