Injury Management Program

We understand the impact a work-related injury can have on your life. It affects not only you, but also your family. Our goal is to help you understand the process, and work with you so you can return-to-work, and the normal, everyday life activities you enjoy.

What do I do if I have an industrial injury, or think I have had an injury or illness caused by my work?

It is important that you report your injury to your supervisor as soon as possible after it occurs. If you require emergency treatment, call 911. If it is an incident with no injury, or a simple first-aid injury you must still report it to your employer. An incident report will be completed to document your injury in the event that medical treatment beyond first-aid is required at a later date. If you require more extensive treatment your employer will provide you with a Workers’ Compensation Claim Form (DWC-1).

2021 Mileage Reimbursement Claim Form

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Notice of Personal Chiropractor or Personal Acupuncturist

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Predesignation of Personal Physician

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Answers to Your Questions about Permanent Disability Benefits

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Answers to Your Questions about Qualified Medical Evaluators and Agreed Medical Evaluators

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Answers to Your Questions about Temporary Disability Benefits

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Answers to Your Questions about Utilization Review

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Basic Facts on Workers' Compensation for Injured Workers

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Facts About Workers' Compensation Injury Management Program

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Glossary of Workers' Compensation Terms for Injured Workers

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Pharmacy Network

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First Aid Letter

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Procedures Beyond First Aid

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Claim Reporting Checklist

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First Aid Letter

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Workability Form for Doctor Visits

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Employer Report of Occupational Injury (5020)

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Incident / Hazard Report Form

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Mitchell Pharmacy First Fill Form

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Pre Injury Occurrence

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For Injury Occurrence

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Need to report a claim?

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