Test File

CON

TEN

TS

02

Professional Claims Intervention Services

02

Professional Claims Intervention Services

1. Employees must notify thesupervisor at the time of injury.

2. The supervisor notifies the corporate office to report the incident. (If the supervi sor is injured, then a member notifies the office.)

3. The supervisor will provide an injury reporting packet to have appropriate forms completed.

4. The supervisor may suggest that the injured worker seeks medical treatment; however, it is the injured employee who determines if medical treatment is required.

5. The supervisor, or another appointed individual, will transport injured employee to nearest USHealthWorks, unless elsewhere is requested. If the injured employee requests to go elsewhere, the injured worker will transport herself/himself to chosen facility.

6. Present the Modified Duties and Transitional Return to Work Policy formto the provider.

7. Obtain a Report of Industrial Injury or Occupational Disease Form from the provider and have the provider complete and submit the form to Labor and Indus tries.

8. Obtain a written release to return to work from the provider and bring it to the office manager.

9. The next day all paperwork from the provider will be received by the office man ager before work is started, and any finishing notes to the incident report will be made.

Call 911 prior to the steps below for life threatening or severe injuries. Follow steps below once someone has called 911 and for all other injuries.

Injury Reporting Procedure

Proliance Surgeons11808 Miracle Hills Dr Omaha, NE68154

PCI - Professional Claims Intervention Services

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