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PLEASE POST!
WHEN AN EMPLOYEE IS INJURED ON THE JOB
YOU MUST PROCEED WITH THE FOLLOWING:
- Contact a preferred
urgent care facility by telephone prior to sending the injured
worker.
A.
Advise the urgent care that
you have an injured worker coming in and you are with Nevada Contractors
Insurance and S&C Claims Services, Inc.
B.
Advise the urgent care that a
mandatory drug screen is required, profile
19254(N).
- Fill out the yellow
Preferred Provider referral slip (located on the blue information
booklet cover). Tear at the
perforation and send it to the urgent care facility with the injured
worker.
A.
Give the injured worker the
blue color booklet under the yellow referral slip.This is his/hers to keep.
B.
Have the injured worker fill
out the Injured Worker Statement and sign the Medical Release Form prior to
going to the urgent care. If there is a medical reason why this cannot be
accomplished, such as bleeding or extreme pain, it may be done after the
urgent care visit.
C.
If an injured worker is
seriously injured and needs immediate care, or is transported by ambulance,
you must have someone take an injury packet to the medical facility and
have it completed as soon as possible.
D.
The injured worker must return
the packet to your office after seeing the doctor, and give you a doctor’s
signed return to work slip or disability slip. THIS IS VERY
IMPORTANT!!!
- If there is a
serious injury, notify S&C Claims Services, Inc. immediately at 873-5115
or the hotline if it is after 5:00 p.m. (800)289-4502. If it is not a
serious injury, collect the completed Supervisor’s Report from the injury
packet, fill out a C-3 Form (correctly and completely), put all
injured workers’ papers, including the return to work/disability slip
from the doctor in the injury packet and mail it to S&C Claims Services,
Inc. as soon as possible. This must be WITHIN SIX (6) WORKING DAYS
OF THE INJURY!
The C-3 Form is the most valuable tool in a
workers’ compensation case. It must be filled out correctly and completely
and faxed to S&C Claims Services, Inc. IMMEDIATELY at
876-5584 with a follow up phone call to ensure the fax was received. The
C-3 Form must then be mailed to S&C Claims Services, Inc. as stated above.
NOTE!!
A strong fine may be levied against your company by the Division of
Industrial Relations if the C-3 Form is not submitted to S&C Claims
Services, Inc. within six (6) working days from the date of injury.
Fill out OSHA Log (if necessary). The
instructions are in the injury packet.
Click
for Printable Version
BUILDERS INSURANCE
COMPANY
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