Procedures for Filing a Workers Compensation Claim

Effective May 1, 2014

New claims are now reported to a third-party vendor:

Company Nurse Injury Hotline

1-855-339-1893

Henderson State University – QR105

Injury Hotline Card

All reports must be delivered to Human Resources within 24 hours of incident.

Non-Emergency Injury Reporting

  • Injured worker who needs medical attention notifies his/her supervisor.
  • Prior to seeking treatment, employee (and the Supervisor, if he or she is available) immediately calls the Company Nurse Injury Hotline which is available 24 hours a day, 7 days a week.  Minor injuries should be reported prior to leaving the job site when possible.
  • All departments should have Company Nurse Posters, as well as wallet cards for supervisors with the phone number and the Henderson State University identification code for Company Nurse.   Company Nurse will gather information from supervisor and employee.
  • Company Nurse (a) provides immediate medical treatment recommendation to the worker and (b) sends the injury report to the Arkadelphia Medical Clinic, the Public Employee Claims Division, and Henderson State University’s Human Resources Department.
  • Employee and supervisor must contact Henderson State University’s Police Department to file an accident report. The employee must bring a copy of the accident report to Human Resources.
  • Injured worker or Supervisor is to come to Human Resources to get a copy of the temporary prescription form that allows for the injured worker to pick up any prescriptions, prescribed by the medical facility, and for the charges to be filed on the worker’s compensation claim. 
  • Henderson State University’s Human Resources Department obtains employee signatures and sends the injury report to the Public Employee Claims Division for processing.

Emergency Injury Reporting

  • Injured worker who needs immediate emergency medical care goes directly to the closest hospital Emergency Room (ER) or call 911 if ambulance is needed.
  • Injured worker notifies his/her supervisor.
  • Supervisor immediately calls the Company Nurse Injury Hotline to report the injury.
  • Company Nurse (a) gathers information about the injury and (b) sends the injury report to the Public Employee Claims Division, and Henderson State University’s Human Resources Department.
  • Supervisor needs to contact Henderson State University’s Police Department to file an accident report. The supervisor must bring a copy of the accident report to Human Resources.
  • Injured worker or Supervisor is to come to Human Resources to get a copy of the temporary prescription form that allows for the injured worker to pick up any prescriptions, prescribed by the medical facility, and for the charges to be filed on the worker’s compensation claim.
  • Henderson State University’s Human Resources obtains employee signatures and sends the injury report to the Public Employee Claims Division for processing.

Injuries Requiring No Treatment (as determined by the employee)

  • Injured worker notifies his/her supervisor.
  • Supervisor and employee complete a Workers’ Compensation Incident Report Form to record job injuries that do not require medical treatment, as determined by the employee.
  • Employee and supervisor need to contact Henderson State University’s Police Department to file an accident report. The employee must bring a copy of the accident report to Human Resources.
  • Henderson State University’s Human Resources Department retains the signed, completed Incident Report Form and the University Police Department accident report as documentation of the incident.
  • If the employee later determines they need medical treatment, please call the toll free number for workers’ compensation claims reporting and follow the steps for reporting the injury and then notify Human Resources.

Forms

Company Nurse Posters, wallet cards, incident report forms, and prescription forms can be obtained from HumanResources@hsu.edu or 870-230-5108.