• If you are injured at work and need to seek medical attention, you will need to complete an employee accident report. You must choose one of the physicians from the list of approved panel physicians. Do not go to a hospital unless it is a true emergency. Your physician will refer you if you need an x-ray.
• You must present an Authorization to Treat form to the doctor’s office at the time of the 1st visit so they will be aware that you have a work related injury and that it is covered by workers’ compensation.
• If the physician writes a prescription for you, you must stop by the central office before having it filled to obtain a Preferred Medical Network Prescription Card. This card must be presented to the pharmacy at the time you order your prescription.
• You are encouraged to schedule follow-up appointments or physical therapy for a time that is not during your scheduled work hours. If you miss work due to an appointment sick leave must be used or you may choose leave without pay. Workers’ Compensation does not reimburse you for that time missed from work for physician or physical therapy appointments.
• If you are injured at work and do not feel at the time of the injury that you need to seek medical attention you still must complete an accident report. You will be asked to sign a Refusal of Medical Treatment form. It only means you did not wish to see a doctor at the time of your injury. You may still seek medical attention if your injury is not healing properly, or you feel you need to see a physician. If you are not sure, it is always best to go ahead and see a doctor.
• You must obtain a Return to Work form from the physician and turn it in to your supervisor.
• If your physician advises you to be absent from work due to your injury, you must notify your supervisor immediately. You must then report to Central Office to complete the paper work for your injury and provide a Return to Work form completed by the physician stating the date you will be released to return to work. When you return to work you must provide an updated Return to Work form stating any restrictions you may have in performing your job. If there are restrictions, your supervisor will make adjustments to your work requirements to fit the restrictions.

If you have any questions, please call:

Janet Dahlin
Central Office
770-504-2320 ext. 1110

Revised 8/14

• PLEASE PRINT A CURRENT EMPLOYEE ACCIDENT FORM AT THE TIME OF THE ACCIDENT.
• Notify Central Office of any accident involving injury of any employee as soon as you are aware of it. If I am not available, let someone at the central office know about the injury so that they can notify our workers’ compensation insurer. Employee injuries must be reported to our insurer on the date of injury in order for me to complete the Employee First Report of Injury which is sent to the State Board of Workers’ Compensation.
• If the employee is seriously injured and requires emergency medical treatment call an ambulance and notify the hospital that an injured employee is en-route. Someone from the school should go with the employee. If the employee is not able to complete an accident report notify the central office of the injury immediately and complete the form as soon as possible.
• If the injury is not an emergency, the employee and supervisor must complete the Employee Accident Report and send it to the central office the same day as the injury in order to be reported to our workers’ compensation insurer. You may fax the report and then send the original by inter-office mail. If the report is incomplete, it will be sent back to you for completion. All blanks must be filled in. If the question does not apply give an explanation (example: Treating Physician: Employee chose not to see medical treatment at this time). Do not leave any blanks. Do not send the employee to the hospital unless it is an emergency situation. The physician will refer them to the hospital if necessary (example: the physician on the panel will refer the patient to the hospital for x-rays, etc.).
• Have all witnesses complete a “Witness Statement” and send to me at central office.
• If medical treatment is needed, the employee must choose a physician from the approved Panel of Physicians. Treatment by other than an approved panel physician in a non-emergency situation is considered unauthorized and all medical charges will be the responsibility of the employee. In a true emergency situation, the nearest emergency location can be used, but only to the extent of the emergency. Follow-up treatment must be provided by an authorized panel physician.
• If the employee is given a prescription by the physician, he/she must come to the central office to get a Preferred Medical Network card. The employee must present the yellow Preferred Medical Network Rx card at the time the prescription is presented to the pharmacy in order to have a prescription filled. We only have a limited supply of these cards. Each card has a unique number so they cannot be duplicated. Since supplies are limited, the employee must pick the card up from central office.
• The employee has the right to choose a physician from the approved panel. Do not choose one for them.
• Encourage the employee to seek medical treatment from an approved panel physician at the time of the injury. In the event the employee chooses not to seek medical treatment until a later date, complete the Refusal of Physician’s Care form and notify me immediately of the date medical treatment is received and the panel physician chosen. The Employee Accident Report form must be completed and sent to me on the day the injury occurred even if the employee does not seek medical treatment.
• Encourage the employee to schedule follow-up appointments or physical therapy after working hours if possible.
• A Physicians Authorization to Treat Employee form must be completed and given to the employee. The employee must present the form to the physician at the time of treatment. In order for Workers’ Compensation to cover the cost of the injury, the physician must know it is a workers’ compensation claim. Sometimes the employee forgets to inform them.
• If the employee is absent from work due to their injury, I must be notified immediately. I need to know all dates of absence related to the work injury. The employee’s absence may affect their salary. It is your responsibility to keep me informed.

For questions regarding workers’ compensation please call

Janet Dahlin
(770) 504-2300 ext. 1110
fax: (770) 504-2305

Revised 7/14