FOR AN ON-THE-JOB INJURY OR WORK RELATED INJURY TO BE ELIGIBLE FOR COVERAGE UNDER WORKER'S COMPENSATION A WRITTEN INJURY REPORT MUST BE RECEIVED BY THE INSURANCE CARRIER WITHIN 7 DAYS.
(Forms near page bottom)
Reporting on-the-job Injuries
Employees shall report to the Department Head or supervisor, all job-related illnesses and injuries at the time they occur, no matter how minor the injury or illness appears. It is the responsibility of the worker's compensation insurance carrier to determine if benefits are allowable. When an employee has returned from Workers' Comp leave please notify Human Resources (ext. 4644) with the return to work date. All medical report forms should also be forwarded to the Human Resources department. Failure to provide notification to the Human Resources Department may result in rejection of claim, placing the health care expense solely onto the employee.
When an on-the-job injury has occurred, an Accident Injury Report Form must be filled out completely by the employee and/or their Department Head or supervisor and returned to the Human Resources Department within two business days after the accident. To view a list of treating doctors, please go to: http://www.pswca.org/ and click on "Provider Directory" or call (866)997-7922.
Health care providers typically contact the Human Resources Department to verify coverage and eligibility. It is helpful therefore, if the employee's Department Head or supervisor notify the Human Resources Department when an employee seeks medical attention. The County may require statements of medical condition and of release to work from the attending physician.
Effective May 1, 2008 Smith County will participate in the Political Subdivision Workers Compensation Alliance to manage the health care and treatment employees may receive if they are injured on the job. If an employee sustains an on-the-job injury or illness, he/she may seek medical attention from a health care facility or provider in the Alliance network. Choosing a health care provider from the Alliance network is required in order for the cost of the medical care to be covered. In an employee’s injury is a life threatening emergency, he/she should go to the nearest emergency room. The County may require statements of medical condition and release to return to work from the attending physician.
Accident Injury Report Form.pdf
Description of Injured Employee's Employment
Direct ReHab Med Location.pdf