WORKPLACE INJURIES AND WORKERS’ COMPENSATION

The following procedure will govern the reporting of workplace injuries and reporting of such to Mains’l’s workers’ compensation insurance company:

1. Any employee who sustains a workplace injury reports the injury on the same day of the injury to their immediate supervisor.
2. The immediate supervisor will fill out at the time of notice the MAINS’L SERVICES, INC. CLAIMS INFORMATION REPORT with as much information as possible and directly fax that form to Mandi Irkfetz at Workers Compensation Modifier Controllers, Inc. (WCMC) 651-501-1493. The MAINS’L SERVICES, INC. CLAIMS INFORMATION REPORT may also be scanned and e-mailed to Mandi Irkfetz at claims@wcmcinc.com.
3. The immediate supervisor will see the employee as quickly as possible and ask the employee to sign and date the PATIENT AUTHORIZATION FOR RELEASE OF INFORMATION form where it says “Date” and “Signature of Patient/Guardian.”; the EMPLOYMENT AUTHORIZATION AND CONSENT form where it says “Dated this day…By…”; the AUTHORIZATION AND CONSENT TO RELEASE INSURANCE RECORDS AND INFORMATION form where is says, “Dated…By…”; and the AUTHORIZATION FOR FILE REVIEW OR RELEASE OF COPIES OF WORKERS’ COMPENSATION CLAIMS FILE where it says “Dated…By…”.
4. The immediate supervisor will fill in the current date, the injury date, and the employee’s full name on the top of the LIGHT DUTY AVAILABILITY form.
5. In California the injured employee will also be provided with a DWC-1 form. The immediate supervisor and/or human resources is required to date the DWC-1 form and provide copies to WCMC and to the employee within one working day of receipt of the form from the employee.
6. Lastly, the immediate supervisor will either directly fax or e-mail these forms to Mandi Irkfetz at the above phone number or e-mail address.
7. The Claim form and the release forms, with the exception of the California DWC-1 form, are accessible at the conclusion of this procedure. 
8. The immediate supervisor will direct any questions or concerns the injured employee may have to Mandi Irkfetz at 651-501-1490.
9. The immediate supervisor will inform the injured employee that light duty work will be available to meet basically any restrictions the doctor may feel appropriate and that the employee will be required to work light duty if any time is lost from work.
10. The immediate supervisor will direct the injured employee to immediately bring all medical papers to their supervisor who will copy and fax or scan those documents to Mandi Irkfetz directly.
11. The immediate supervisor will finally e-mail a copy of the MAINS’L SERVICES, INC. CLAIMS INFORMATION REPORT to their Human Resource Generalist A designated Human Resources Generalist will prepare and maintain the required OSHA 301 reports on each reported injury.

In Minnesota the injured employee may select their own medical provider for treatment. It is the employee’s decision whether to be treated for an injury.

In California the injured employee will have either designated at the time of employment a medical provider of their choosing or will be required to seek treatment from a provider listed in the State Medical Provider Network (MPN). The MPN is available at the main office through human resources.

If the employee uses work time to go to the doctor on the day of the injury, the employee will be paid through the end of the shift. If additional time is required, the employee can use accrued sick time or Paid Time off (PTO).
 
Employees are on notice that all comments, job refusals, refusals of employment, or statements that may have a bearing on a workers compensation claim will be reported to WCMC.

WCMC will issue weekly progress reports to Mains’l Services, Inc. on all claimants and claims activities which will be reviewed carefully for progress on recovery and compliance with medical requirements.