Office of Human Resources

RESPONSE to an EMPLOYEE INJURY
Don't
forget - in an emergency call 911
First, all supervisors
should read the materials available on the DOER
website
http://www.doer.state.mn.us/ei-wc/eidwc.htm to be prepared in case of an
injury at work.
The most important thing
to remember is that if an employee is injured,
call 911 as
needed,
call the CMC as soon as possible, notify the HR office staff as soon as possible, and
complete the necessary forms as soon as possible.
There are substantial dollar consequences for failure to file paperwork in a
timely manner, so please complete the paperwork and get it to the HR office
as soon as possible.
PROCESS REVIEW
Remember: If one of your
employees has an injury on the job, you MUST complete an incident report
form. Please send this completed form to HR. If the employee EVER loses
time on the job or has medical expenses associated with that injury, you
must complete a First Report of Injury form immediately and sent it to Shari
Henry for processing and coordination with DOER worker’s compensation
unit. It is the supervisor’s responsibility to complete the forms and
should speak with the employee to complete all areas on the form. Please
note that the supervisor must advise the employee of their rights and
responsibilities regarding this information. The Information and Privacy
Statement form is at http://www.doer.state.mn.us/adsv-sm4/sm4-frms/sm4-pdf/infpriv.pdf and
should be signed by the employee and returned with any forms to HR.
FORMS REVIEW
ALL INJURIES (2 forms) –
The Information and Privacy Statement form and Incident Report Form
NO LOST TIME OR MEDICAL
EXPENSES (2 forms) – The Information and Privacy Statement form and Incident
Report Form
MEDICAL EXPENSES OR LOST
TIME (3 forms) – The Information and Privacy Statement form, Incident Report
Form and First Report of Injury.
The First Report of Injury
Form can be found at
http://www.doer.state.mn.us/ei-wc/pdf/Fri.doc
The Agency Incident Report
Form can be found at
http://www.doer.state.mn.us/ei-wc/pdf/Pe630.doc
EMPLOYEE INFORMATION
Wondering what information
is available for you to give the employee. Here is general information to
provide the employee -
http://www.doer.state.mn.us/ei-wc/inj-work.htm
CLINIC INFORMATION
Important note for state workers who need health care for treatment of
job-related injuries:
CorVel is the
certified managed health care plan under contract with the State Workers’
Compensation Program to cover all state employees for work-related injuries
and illnesses. Employees may call
CorVel's 24-hour Nurse Phone Line at (612)
436-2542 or (866) 399-8541 to speak with a nurse about their work-related
injuries and illness. You may also contact CorVel's Nurse Phone
line if you have questions about managed care for workers' compensation; or
direct such inquiries to the State Worker's Compensation Program at (651)
296-6521.
If an employee goes to
his/her own clinic or a clinic that is not our designated clinic, he/she may
be liable for their own expenses. The clinic assigned to IHCC is:
Designated CorVel Network Clinic:
Allina
Medical Clinic
1110 Yankee Doodle Road
Eagan,
MN 55121
651-454-3970
Hours: Monday -
Thursday: 7 am to 8 pm
Friday: 8 am to 5 pm
Obstetrics-gynecology appointments 8 am to 5 pm
Saturday: 9 am to noon (same day appointments only)
IF YOU ARE UNABLE TO OBTAIN AN INITIAL
APPOINTMENT WITHIN 24 HOURS AT THE DESIGNATED FACILITY, CALL THE CORVEL 24
HOUR INFORMATION LINE.
24 HOUR INFORMATION LINE - 612-436-2542 or
866-399-8541
After Hours Care:
Allina Medical Clinic
Woodbury Clinic
651-501-3414
Hours:
Monday - Friday, 3 - 10 pm
Saturday & Sunday, 9:00 am - 4:00 pm
Emergency:
United Hospital
333 North Smith Avenue
St. Paul, MN 55102
651-241-8000
Please present the Patient Identification Card to
the medical provider when you begin treatment.
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