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Worker's Compensation Forms and Information

  • For Faculty, Staff

Workers Compensation Insurance (WCI) will pay all reasonable medical expenses incurred as a direct result of injuries sustained during the normal course and scope of an employee’s job. In addition, WCI provides weekly compensation for employees who lose time from work and death benefits for employees who die as a result of on-the-job injuries.

The following tasks are included below:
-**Employee Injury Report**: To be completed by the injured employee
-**Health Care Network Employee Acknowledgement Form (English and Spanish)**: To be completed by the injured employee
-**Important Information for Medical Treatment**: To be provided to the employee for review
-**Supervisor Accident Report**: To be completed by the supervisor of the injured employee

Additionally, please review your Treatment Location Options.


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