Workers' Compensation Insurance provides payments to employees for medical treatment and wages lost as a result of a work-related illness or injury. Employees are not responsible for the cost of medical treatment when such treatment is directly related to a work-related injury or illness.
Please refer to the Workers' Compensation Policy and Procedure before proceeding with any forms.
Work Related Incident or Injury
You must notify your supervisor immediately of any work related incident, injury or illness.
Notify your Human Resources Representative of all work related incidents and injuries.
- Supervisors and HR Reps only can use the Work Related Incident - Injury form to submit Workers' Compensation claims.
Returning to Work
If an employee has been out of work as a result of a work related injury / illness they must provide medical written authorization before being able to return to work.
If an employee has been out of work 3 or more days as a result of a work related injury/illness their treating physician must complete the "Work Related Injury / Illness – Physician's Status Report" before being able to return to work.
Workers' Compensation Notices
The below Notices of Compliance To Employees outline your rights as an injured worker and provide proof of Workers' Compensation insurance coverage.
- New York State Workers' Compensation Poster (PDF)
- Colorado Workers' Compensation Information (PDF)
- Colorado Notice to Employer of Injury (English PDF) (Spanish PDF)
- District of Columbia Notice of Compliance (English PDF) (Spanish PDF)
- Illinois Workers' Compensation Workplace Notice (English PDF) (Spanish PDF)
- Massachusetts Notice to Employees (English PDF) (Spanish PDF)
- North Carolina Workers' Compensation Notice (English PDF) (Spanish PDF)