FLOWCHART OF WORKERS’ COMPENSATION PROCESS
FOR EMPLOYEES OF MOHAVE COUNTY SUPERIOR COURT
If the injury is life threatening, Employee is to
Injured employee calls Richard Weldon at cell phone #
seek emergency help immediately by calling 911.
303-1561 to advise that an injury has occurred.
Depending upon the nature of the employee’s injury,
Richard will assist the employee in obtaining first aid
through Chris Renner, Mohave County Occupational
Health and Wellness Nurse and/or medical treatment
If the injury is not life threatening, Employee
preferably at an occupational medical service provider.
notifies their supervisor
Supervisor completes SRI Form (Supervisor’s If employee seeks medical
Report of Injury) providing as much detail as treatment, employee should notify
possible about how the injury occurred. the doctor they were injured at
work. Employee and physician
Supervisor immediately (within 4 business hours) complete 102 (Workers’ and
faxes SRI form to Richard Weldon, Mohave Physician’s Report of Injury) form.
County Risk Manager, at 928-718-4954.
Supervisor sends the original white and pink
copies of the SRI form to R. Weldon, Mohave
County Risk Mgmt. and gives the blue copy to the Physician sends copies of 102 to
injured employee to provide to the treating Industrial Commission of Arizona (ICA),
physician (if medical treatment is sought). State Risk Mgmt. and Mohave County
Risk Mgmt. Employee retains copy.
Richard Weldon enters report
through Internet on
WebEnvisions (only if medical ICA sends notification to
treatment was sought) State Risk Management
STATE OF ARIZONA WORKERS’ COMPENSATION
State Risk Management receives all communication regarding the
injury and adjusts the claim. During the claims adjusting process
workers’ compensation communicates with the injured employee,
supervisor, physician, Richard Weldon and the Industrial Commission
(ICA) for follow-up and pertinent information.
For more information regarding workers’ compensation benefits through the State of Arizona including (filing a claim,
timeframes for reporting an injury, seeking medical care, the claims process, returning to work after an injury, types of
compensation benefits, etc.) visit: http://risk.az.gov/agency_information/workers_compensation/default.asp Rev. 8/6/10