Workers’ Compensation Program /\Summit

Post-Injury Procedure  Injury occurs  Assess the situation  How severe is the injury?  First-Aid Only  Minor/Moderate injury Requiring Treatment  Severe – requiring immediate and significant treatment.  Notify Summit  Include any information that may be pertinent to the claim.  Submit Wage information if necessary  Keep Summit Updated

First-Aid Only  Submit Quick Report to Summit  Quick Report (Form 100) Quick Report (Form 100)  This is necessary in the event the employee needs treatment at a later date.  Does not require wage information

Minor to Moderate Injuries  Send the injured worker to an IHS facility if possible.  Provide the employee with our information sheet, and let them know they are responsible for notifying the medical facility of the work- related injury, and for keeping both Summit and their Human Resources department updated on their condition.  Provide Injured Worker’s Information Sheet to employee  Remind the employee that light duty work may be available, and that they cannot be paid for time missed from work without a note from the treating doctor.  Submit Employer’s Report of Injury form to Summit.  Quick Report (Form 100) if no time missed from work in excess of Seven (7) days. OR  If Employee is likely to miss more than seven (7) days from work, fill out the Employer’s Report of Injury (Form 101) and include the wage portion at the bottom of the form.  Going forward, continue to fax copies of work slips and/or medical updates.

Severe or Catastrophic Injuries  Secure immediate medical treatment for the employee.  Contact Summit by phone and/or immediately.  IHS must be notified within 72 hours. If they are not notified, we cannot save you the cost of these services which can be significant.  Submit Employer’s Report including wage information. Employer's Rpt (101).docEmployer's Rpt (101).doc  As with other claims, continue to fax work slips or medical updates to Summit.

Wage Information  The best, most accurate way to establish wage is by using the employee’s annual salary.  When submitting the wage information, use exactly one year prior to the injury.  Example: If the date of injury is 08/17/2013, you will submit earnings from 08/17/2012 through 08/16/2013.  Since the employee did not work a full day when he/she was injured, the date of injury is not used.  If the employee has been employed for less than one year, but they have an annual salary contract, submit this information.  If the employee has been employed less than one year, and is an hourly employee, indicate the employee’s date of hire and include all earnings from the date of hire through the day prior to their injury.  If you are not sure how or what to submit for earnings, call Tami at (480)

How is Compensation Paid?  The day of injury is not payable. Compensation begins the first full day the employee is placed off work by their physician.  If there are fewer than 7 days missed from work, compensation will not be paid – this is considered a “no time lost” claim.  If there are fewer than 14 days missed from work, the first 7 days will not be paid. Compensation will begin on the 8 th day off work and continue through the day prior to returning to work.  If more than 14 days are missed from work, compensation will be paid beginning the first day of the work restrictions (not including the day of the injury).