Employee worker's compensation checklist

It is necessary to file a worker's compensation claim with Eberle Vivian if an employee seeks medical treatment for any injury or illness the employee thinks may have resulted from work activities. Worker's compensation insurance is separate from private health insurance or any other health insurance coverage provided by PSE or a collective bargaining agreement. Private medical insurance will not provide coverage for work-related injuries and illnesses. If an employee has already been receiving medical treatment for an injury, it is important that he/she files a worker's compensation claim immediately. Any delay or failure to file within the time limits outlined below may result in a denial of benefits.

To file a worker's compensation claim, an employee must:

• Immediately report the injury or illness to his/her supervisor.
• Obtain the worker's compensation packet and review all contents.
• Complete the top portion of the Self-Insurer Accident Report form (SIF-2) right away. The employer portion on the bottom where it reads “Employer start here” is for the supervisor to complete. Return the top three copies to the supervisor. Keep the pink copy. If a pink copy was not provided, the employee should request it.
• Complete the Report of Industrial Illness or Injury, and turn it in to his/her supervisor as soon as possible, no later than within six calendar days from the injury date.
• Receive treatment from a licensed physician and ask him/her to:
  • Complete a Physician’s Initial Report, and
  • Fax the form in the envelope provided to: Eberle Vivian, 253-854-6404
• An employee who is able to work in any capacity but has limitations should have his or her physician complete the Insurer Activity Prescription form (APF) and submit it according to the instructions on the bottom of the form.
• Call MetLife at 1-877-8OFFWORK (1-877-863-3967) to report how much time he/she has missed from work for the initial medical appointment and also to report any subsequent time off work for follow-up treatment and recovery. The worker's compensation claim does not pay for hours missed from work for medical appointments approved under the claim, but PSE can compensate employees for this time without requiring them to use PTO.

If employees need time off to recover:

• Their physicians will need to provide documentation to Eberle Vivian (question 9 on the Physician’s Initial Report addresses this).
• Employees should notify their supervisors and follow the absences procedures of their workgroup.
• Call MetLife at 1-877-8OFFWORK (1-877-863-3967) for time taken off work for medical appointments. This will provide Human Resources the information needed for payroll and benefits purposes. MetLife also determines eligibility for family medical leave. The Family Medical Leave Act is a federal law that provides legal protections that worker's compensation law does not. For additional information, ask MetLife.
• Employees who anticipate they will be able to return to work soon should refer to the Employee Checklist for Returning to Work Following a Medical Leave of Absence.
  This page contains information employees need to know before they are released to return.

For questions about an employee's rights or how to file a claim, contact Eberle Vivian at 253-867-1781 or toll free at 1-800-927-9448.

To provide comments regarding Eberle Vivian's services, call PSE’s Leaves and Accommodations Program at 425-462-3278.