Home   
Site Menu
Philosophy
What We Do
Our Staff
What To Do If An Employee Is Injured
Customer Service
Preferred Clinic And Hospital List
Forms -
C3 and D-8
Arizona Forms and Provider List
California Forms and Provider List
Idaho Forms
S&C Claims Utah
S&C Claims Missouri
Home

PLEASE POST!

WHEN AN EMPLOYEE IS INJURED ON THE JOB

YOU MUST PROCEED WITH THE FOLLOWING:

 

  1. Contact a preferred urgent care facility by telephone prior to sending the injured worker.

A.     Inform the urgent care that you have an injured worker coming and you are insured by an insurance carrier that contracts with S & C Claims Services for claims administration.

B.     Advise the urgent care that a mandatory drug screen is required, profile 19254(N).

 

  1. 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!!!

 

  1. 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 worker's 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

AMTRUST INSURANCE
COMPANY 

BUILDERS INSURANCE
COMPANY

COMPANION COMMERCIAL
INSURANCE COMPANY

COMPANION PROPERTY & CASUALTY
INSURANCE COMPANY

NEVADA MUTUAL INSURANCE COMPANY

UTAH BUSINESS INSURANCE COMPANY

BENCHMARK INSURANCE COMPANY

FIRST CHOICE CASUALTY INSURANCE COMPANY