If an injury has been reported to your company during the course of employment for our employee(s), the following steps will help us direct the employee for medical care in the most efficient and expeditious manner.
INJURY REPORTING STEPS AND PROCEDURES
1. WHEN INJURY IS DEEMED URGENT OR EMERGENT:
i.e., “severe chest pain or difficulty breathing, compound fracture (bone protrudes through skin), convulsions, seizures, loss of consciousness, heavy-uncontrollable bleeding, moderate to severe burns, poisoning, severe head, neck, or abdominal pain, sudden loss of vision, numbness, weakness, slurred speech, or confusion” please handle the injury by calling 911 or having someone onsite take the employee to the nearest emergency room or urgent care.
Please note: After emergency care, the Workers’ Compensation Liaison will contact the employee to schedule the first appointment with one of our preferred medical providers or facilities.
WHEN INJURY IS DEEMED NON-URGENT OR NON-EMERGENT:
Medical treatment is necessary contact the injury reporting line at the contact number provided above. The Workers’ Compensation Department will designate care and provide the employee with an appointment as well as address to a preferred medical provider or facility for treatment.
2. EMPLOYEE INJURY REPORT FORM
Have the employee complete the EMPLOYEE INJURY REPORT FORM in its entirety with as many details as possible. If the employee is unable to complete the EMPLOYEE INJURY REPORT FORM, the workers’ compensation department shall complete one with the employee post injury.
3. SUPERVISOR’S REPORT
SUPERVISOR’S REPORT is required to investigate the injury and determine the compensability of the claim and the work duties as it related to the injury. This must be completed by a supervisor or department lead that oversees or designates the duties for this employee. Please designate the appropriate contact for correspondence as it relates to the employee’s injury.
4. WITNESS STATEMENT
(if applicable), WITNESS STATEMENT is also valuable to corroborate and add details for the injury as witnessed.
5. DECLINE TO TREAT
(if applicable), to support medical treatment was offered and the employee declined. Any and all correspondence or conversation logs if available will also assist in the determination of direction for the injury claim.
Representatives from the Worker’s Compensation Department will be contacting the designated personnel listed on the supervisors report to provide work status report as well as correspondence for details related to the investigation of the injury.
Ensure that medical documents are sent IMMEDIATELY to the Workers’ Compensation Department so we can process the workers’ compensation benefits and or request for medical treatment expeditiously and efficiently. Without sufficient, supporting medical evidence and medical documentation delay and or denial of treatment can occur. A decision on a claim must be made within 5 days of the Workers’ Compensation Department receiving notice of you injury. Therefore, in order for this Department to provide benefits, cooperation in obtaining this documentation is critical.
The revised REPORTING FORMS are available from our site should your company not have reporting forms onsite however we have found in most circumstances, our customers have their own reporting forms and this documentation is absolutely acceptable and in fact preferred as we want to maintain the consistency within your organization as well.
Workers Comp Contact Info
INJURY: (559) 403-8806
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INJURY: (559) 517-4927
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9170 HAVEN AVE. STE 105
RANCHO CUCAMONGA, CA 91730
OFFICE: (909) 484-0400
FAX: (909) 484-0410
|INJURY: (909) 204-8441
INJURY FAX: (909) 475-6324
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INJURY: (559) 403-6421
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