This Workers' Compensation Program aims to provide prompt and effective medical treatment for employees who sustain work-related injuries or illnesses. The program outlines the process of reporting injuries, filing claims, and returning to work.
To outline the process and requirements for obtaining workers' compensation benefits.
Applicable to all employees of [Company].
Section | Role/Responsibility | Purpose |
Employee Responsibilities | Report injuries immediately | To ensure prompt medical attention and proper documentation |
Complete required documentation | To initiate the workers' compensation claim process | |
Comply with medical treatments | To expedite recovery and return-to-work process | |
Employer Responsibilities | Provide a safe work environment | To minimize risks and hazards in the workplace |
Furnish required forms for claiming benefits | To facilitate the administrative aspect of the claim process | |
Investigate reported injuries | To identify the cause and take corrective actions if necessary | |
HR Responsibilities | Process claims | To ensure eligible employees receive their entitled benefits |
Monitor recovery and facilitate return-to-work | To aid the employee in reintegrating into the work environment | |
Maintain records | For compliance and documentation purposes | |
Medical Provider | Offer immediate and appropriate medical care | To provide initial treatment to minimize complications |
Complete medical report forms | To document the injury and treatment for administrative purposes |
Employees must report any work-related injuries to their supervisor and Human Resources within 24 hours.
Stage | Action Item | Responsible Party |
Step 1 | Initial report of injury | Employee |
Step 2 | Supervisor's Incident Report | Supervisor |
Step 3 | HR Incident Log Entry | Human Resources |
Initial Assessment: Conducted by [Name of Medical Provider]
Claim Submission: To be submitted by HR to [Insurance Provider]
Claim Approval/Rejection: Decision by [Insurance Provider]
Form or Document | Submission Deadline |
Initial Medical Assessment Report | Within 24 hours |
Worker's Compensation Claim Form | Within 5 days |
Assessment of Readiness: Conducted by [Medical Provider]
Temporary Work Assignments: Possible pending medical clearance
Employee Incident Report
Supervisor's Incident Report
Medical Provider's Initial Assessment
Workers' Compensation Claim Form
The program will be reviewed annually by [Name, Position].
HR Manager: [HR Manager's Name]
Address: [Company Address]
Phone: [Contact Phone]
Email: [Contact Email]
Appendix A: Employee Incident Report Template
Appendix B: Supervisor's Incident Report Template
Appendix C: Medical Provider's Initial Assessment Template
Appendix D: Workers' Compensation Claim Form
By following the procedures outlined in this Workers' Compensation Program, [Company] aims to ensure the well-being of all employees through effective and compassionate care.
Templates
Templates