Workers Comp Claims Reporting Checklist

Strategic Focus Clear Vision Defined Strategy. Proven Results.

WORKERS' COMPENSATION CLAIM REPORTING

3540 E. Broad St. Store 6870 #126 Mansfield, Tx 76063

Fax: 1 214 833 7257 Email: claims@stratfocusllc.com

All claims should be reported to Strategic Focus PEO within 24 hours and a drug test is required within 24 hours of all reported incidents.

IF AN EMPLOYEE IS INJURED ON THE JOB, FOLLOW THE STEPS BELOW TO REPORT A

CLAIM

EMPLOYER to Complete the EMPLOYER INCIDENT REPORT EMPLOYEE to Complete the EMPLOYEE INCIDENT REPORT

For Medical Treatment - Please complete/provide the following

Provide Employee with Authorization for Medical Treatment & Release for Medical Records Form to complete/sign. (Employee takes COPY of form to doctor) Locate your Medical Provider List or Panel of Physicians to locate a Medical Provider Provide Employee with a copy of the Temporary Prescription Card If Employee REFUSES Medical Treatment, have the employee complete and sign the REFUSAL OF MEDICAL TREATMENT FORM

Post-Accident Drug Test - Employee must adhere to a mandatory drug screen even if no medical treatment is required.

Employee Sent for the REQUIRED Post-Accident Drug Test

If this was an Auto Accident - Please complete/provide the following

Completed Auto Accident Report Form Copy of the Driver Information Exchange, Statements and a Police Report if available

E-Mail All Completed Reports To: claims@stratfocusllc.com

If you have any questions, please contact the Strategic Focus HR Coordinator at (214) 888-6776