Employer's Responsiblity Regarding Injury or Incident

In the event of injury or incident the supervisor should follow these steps:

1. Complete the Industrial Commission IC19 form (Employer’s First Report of Injury) to the agency third party carrier: Key Risk Management, Inc.
2. Contact injured employee and provide information regarding benefits available under Workers’ Compensation.
3. Provide employee with a Workers’ Compensation Handbook (provided by the Office of State Personnel) and notification (memo) of claim being filed with the third party carrier.
4. Manage claim along with third party administrator. Process and submit all reports, claim forms and medical information pertaining to the injury regarding the claim being filed.
5. Contact with third party carrier of medical status of the injured employee including all matters of, prescribed medications, pharmacist, physicians, medical charges, and time away from work due to and pertaining to the injury.
6. Follow through the duration of claim involving activity or non-activity of claim. Must report each claim filed whether its OSHA recordable to OSHA Safety & Health Administration of recording.

   Note to the Supervisor and Injured Employee:

   1. The Workers’ Compensation Act states that the employer shall direct the injured employee to the physician of the employer’s choice.
   2. The employee can only select a physician with written prior approval for the Industrial Commission.
   3. The Industrial Commission has a set fixed scheduled in which providers are reimbursed up to an allowable amount for a particular procedure.