Flowchart of Workers Compensation Process by xiaoyounan


									                                 FLOWCHART OF WORKERS’ COMPENSATION PROCESS

                                                        INJURED EMPLOYEE

  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

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