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

9.30 KB

Predesignation of Personal Physician

13.58 KB

Answers to Your Questions about Permanent Disability Benefits

208.52 KB

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

249.60 KB

Answers to Your Questions about Temporary Disability Benefits

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Answers to Your Questions about Utilization Review

314.91 KB

Basic Facts on Workers' Compensation for Injured Workers

268.86 KB

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

260.02 KB

First Aid Letter

627.81 KB

Procedures Beyond First Aid

786.89 KB

Claim Reporting Checklist

272.33 KB

First Aid Letter

627.81 KB

Workability Form for Doctor Visits

29.98 KB

Employer Report of Occupational Injury (5020)

238.33 KB

Incident / Hazard Report Form

46.50 KB

Mitchell Pharmacy First Fill Form

399.68 KB

Pre Injury Occurrence

55.67 KB

For Injury Occurrence

56.90 KB

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