303 North Church Street • Murfreesboro, TN 37130 • Phone: (615) 898-7715 • Fax: (615) 867-4602

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Filing a Claim

All accidents, injuries or illnesses are to be reported to the supervisors as soon as possible after the occurrence. If the accident involves loss of consciousness, a fatality, broken bones, loss of a body part or third degree burns, the supervisor should be notified immediately. It is then the responsibility of the supervisor to immediately notify the Safety Coordinator.

The following steps should be followed when injured:

• Report to your Supervisor that you have been injured.

• Fill out the First Report of Injury form and submit the completed form to your supervisor. The form must be signed by your supervisor.

• Select an authorized physician from the Panel of Physicians. Complete and sign the form. Be sure to keep a copy for your records.

• If you so desire, seek medical treatment from the physician you selected from the Panel of Physicians. Do not go to your primary care physician – it is not protocol and will not be paid for through workers' comp.

• ER visits are NOT protocol, unless there is a dire need (e.g. a broken bone, torn ligament or bleeding profusely). However, if a work related injury happens after hours during the week or the weekend, you are permitted to utilize the ER – provided your supervisor is aware of the injury.

• Notify your supervisor of your condition and when the physician recommends you return to work.

• To avoid out of pocket expenses, prescriptions should be filled at one of the authorized pharmacies.

• If the physician recommends light or restricted duty and your supervisor can provide a job within your restrictions, you MUST report to work. Failure to report will terminate your workers’ compensation benefits.

• The supervisor shall complete the Return to Work Agreement by listing the light duty jobs that fall within the employee’s restrictions. The supervisor shall also explain the restrictions to the employee and have the employee sign the agreement as acknowledgement of understanding the restrictions.

• If there is no light duty available, you will be out of work and paid through workers’ comp.

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