What To Do If You Have A Claim
In the event of an injury, necessary forms which should be in your Workers’ Compensation binder should be filled out. These same forms are also below and can be printed out.
Please complete the entire injured worker section ONLY (top half of page). If possible the employee should take the completed form to the medical provider.
This form should be filled out as completely as possible including any witness statements.
This form should be signed and dated by the employee.
These need only be filled out if the employee will miss more than 7 days from the date of injury.
Injured worker is released to work light duty by their physician of record, and their employer is able to accommodate such restrictions. This offer must be given in writing.
The injured worker can be treated at a facility of their choice, and in any life threatening situation the closest emergency facility should be used.