Worker’s Compensation

1. Worker’s Compensation

2. This presentation will hopefully help to explain a little about worker’s compensation and get you acquainted with the forms that need to be completed if you have a work related injury. Please feel free to contact Deb Hanson in the Human Resources office at 232-2140 if you have questions that this presentation does not answer.

3. The first thing you should do if you are injured at work is report the injury to your supervisor. If the injury requires medical attention, see a doctor right away. Make sure to tell the clinic or hospital that your injury is work related and the billing should be sent to the following address. UW-Stout Human Resources Office Attn: Deb Hanson P.O. Box 790 Menomonie, WI 54751

4. Required Forms There are several forms that must be completed to file a worker’s compensation claim. The forms should be completed and submitted to Human Resources within five days of the accident. Since each claim is different, there may be additional forms for some claims but the basic forms are: • Injury & Illness Report (completed by employee) • Employer’s First Report of Injury (completed by supervisor) • Supervisor & Safety Coord. Accident Analysis & PreventionReport (completed by supervisor & safety coord.) These required forms are on the following three slides.

5. Injury and Illness Report This required form needs to be completed by the employee: http://www.uwsa.edu/oslp/wc/forms/OSLP-1EmpForm.doc (Please print the form, complete it and give it to your supervisor.)

6. First Report of Injury This required form needs to be completed by the supervisor: http://www.uwsa.edu/oslp/wc/forms/wkc-12.doc (Please print the form, complete it, attach other documents and submit to the Human Resources Office within five days of injury.)

7. Accident Analysis & Prevention Report The supervisor’s portion of this required form should be completed and then sent to Human Resources: http://www.uwsa.edu/oslp/wc/forms/slp2su.doc (Please print the form, complete it, attach Employee’s Injury & Illness Report and Employer’s First Report of Injury or Disease and submit to the Human Resources Office within five days of injury.)

8. Information The following slides are provided for information only.

9. Supervisor Information This page explains employer & insurance carrier instructions. It also explains which sections of the forms are mandatory information. Employer and Insurance Carrier Instructions

10. Employee Information This page gives the employee some worker’s compensation information that is very helpful. WC Fact Sheet

11. Facts For Injured Workers This link will take you to a publication from the Wisconsin Department of Workforce Development and has some very good general information about worker’s compensation. Facts for Injured Workers

12. More Forms The following forms only need to be completed when requested.

13. Medical Release This form is needed to access past medical history. It is only used when an injury has affected an area of the body that may have had a previous injury. In such a case, we also need a listing of physicians that the employee has seen in the last five years. WC - Authorization for Release of Medical Information WC - MD Listing

14. Mileage Record This form is used to report mileage traveled to doctor appointments, physical therapy, etc. for reimbursement. WC - Mileage Record