Upon knowledge of an injury, a supervisor will take the following actions:

The employee DOES NOT want medical treatment:

The supervisor will complete a Supervisor's Investigation Report and send it to Risk Management, Attn: Loss Prevention Specialist. The Department will note on the report that medical treatment was offered and refused by the employee.

The employee DOES want medical treatment:

The supervisor will:

1. Provide options for medical treatment to the employee: There are two options:
   • Ask the employee if they have a Pre-designated Physician form on file. If so, refer the employee to that physician. If time allows, verify that the pre-designated physician form is in the employee's personnel file. Do not delay treatment. Workers' Compensation will ask the department to verify a pre-designated physician form is on file prior to authorizing any additional treatment.
   • If the employee does not have a pre-designated physician, give the employee a Request for Medical Service form and instruct the employee to choose one of the Primary Treating Physicians listed. The employee does not need to make an appointment for initial treatment with these providers. However, the employee may want to call ahead to determine the wait time.
   Instruct the employee to provide the department with a work status slip after the appointment.



2. Have the employee complete the top portion of the Workers' Compensation Claim form. The department will complete the bottom portion and send the claim form to Workers' Compensation Services immediately.

3. Give the employee the and the Sick Leave Use Option form and instruct the employee to complete these forms and return them to the employer with the work status slip the employee is going to obtain from the medical provider.

4. The Department will complete the Employer's Report of Occupational Injury or Illness form and and send them to Workers' Compensation Services immediately.

The employee is UNSURE about medical treatment:

The Supervisor will provide the Request for Medical Service form and a Workers' Compensation Claim form to the employee. The Supervisor will inform the injured employee of the options for medical care (see item #1 above) and the need to complete the Claim form only if he/she seeks medical treatment. The Department will complete the Supervisor's Investigation Report and send a copy to Workers' Compensation Services. The Department will note on the report that medical treatment was offered and refused.