What Should You do if you get hurt at work?
If you get seriously hurt at work and need medical treatment, you should go directly to the nearest emergency room or urgent care center for treatment.
Please immediately notify us of the injury and we will fill out a Form C-1, Notice of Injury or Occupational Disease – Incident Report. Fill out the C-1 completely, sign and date it. We will then sign and date the C-1. You have 7 days to complete the form.
The actual workers’ compensation claim begins with the completion of the Form C-4, Employee’s Claim for Compensation/Report of Initial Treatment. The C-4 is supplied by the medical provider at the time of initial treatment.
You need to fill out the top portion completely; including the correct name, correct address and correct phone number of your actual employer, the date of injury and your contact information. Missing, incomplete or inaccurate information will delay the process.
You will then sign and date the C-4. The medical provider will complete the bottom portion and the treating physician or chiropractor will sign and date the C-4. The medical provider has 3 working days from the date of treatment to forward the C-4 to the correct insurer/TPA and to the correct employer. The C-4 is not valid until both parties have signed and dated it. There is no claim until a Form C-4 has been completed and filed with the correct claims administrator.
You have 90 days from the date of injury or knowledge of the onset of an occupational disease to file a workers’ compensation claim.
You must go to an authorized medical provider who is a member of the Panel of Treating Physicians and Chiropractors.
In the event of a serious injury, you should go directly to the nearest emergency room for treatment. For less serious injuries, you should seek treatment from an authorized medical provider chosen from our insurance company’s preferred provider list. Once the claim is filed, you will receive a letter (and a phone call) from the insurance company’s representative and they will help you with any information and questions regarding your benefits.
The insurance company has 30 days after receipt of accident notification (Form C-4) to accept and begin payment on the claim, or deny the claim and notify you or your representative of the denial. Claim denials must include your appeal rights. NOTE: We do not decide on this issue, it’s completely up to the insurance company to handle your claim.
Here’s the brochure in Spanish.