Quil Ceda Village Health and Safety

In order to avoid delay in the processing of workers compensation benefits the employee should immediately report the injury to their supervisor and to the Health and Safety Department.

The supervisor should interview the employee about how the injury occurred and complete an internal incident report. The internal incident report should be given to the Health and Safety Department.

The supervisor should provide the employee with a Claim Packet and instruct the employee to return the packet to the Health and Safety Department within three days in order to avoid a delay in the processing of their benefits.

The employee must complete the "worker section" of the Accident Report form PRIOR to going to the doctor. In emergency situations this form must be completed as soon as the employee is able to do so. Employees also need to complete the Employee Report of Accident form to submit with their other forms.

The accident report must be completed fully and provide a detailed description of how the injury occurred. If the Accident Report is not completed fully or the information being provided is unclear, there will be a delay in the workers compensation benefits. Along with the Accident Report an Supervisor Report of Accident and if available a Witness Report of Accident must be submitted.

The employee will be required to take a Return to Work Authorization / Disability Certificate form to the doctor (the form will have to be signed by a licensed Medical Doctor, or a qualified physician) for completion. This form must be returned to the Supervisor and the Health and Safety Department on the same day. Failure to return the form will affect their worker's compensation benefits. A copy of this form must be sent to the Tribal First for consideration of benefits.

The employee will also be required to take the Physician's Initial Report to their first treating physician for completion. This form must be completed immediately and sent to Tribal First.

The employee should have weekly contact with the Supervisor and the Health and Safety Department staff to provide reports on their progress.

An employee may not take Sick, Annual, or Personal Leave while claiming time loss benefits under the worker's compensation claim. If the employee is off work as a result of the injury he/she should be put on a leave of absence without pay from the employer.