EMPLOYEE INCIDENT REPORT
Please provide all information requested:
The following information is being provided in order to help you as you progress through your workers’ compensation claim:
On the date of injury/incident, please complete the Employee Incident Report.
If treatment is required, obtain an Authorization for Treatment (valid only when signed by Supervisor or their designee) at the Agency’s Board Approved Occupational Clinic: RediCare.
4185 E. Grand River Ave.
Howell, MI 48843
***PLEASE NOTE*** When authorized to leave work early to receive medical attention/treatment on the day a work related injury occurs, you will not lose pay or have to use sick/personal time for the portion of the day lost.
You may only receive treatment from RediCare during your first twenty-eight (28) days after your injury. If, after the initial twenty-eight (28) days, you prefer to seek treatment from your own physician, please contact your CCMSI representative as listed below.
If you are taken off work due to a work related injury, please review the information below; it is your responsibility to:
Workers’ Compensation Claims Adjuster(s) for claims involving employees having missed 0 – 7 calendar days of work: Tara Kavanagh or Haley Magwood
Workers’ Compensation Claims Adjuster(s) for claims involving employees having missed 8 - 15 calendar days: Amanda Parsons
Workers’ Compensation Claims Adjuster(s) for claims involving employees having missed 15+ calendar days: Mark Rue
CCMSI Contact Information
2364 Woodlake Dr., Suite 100
Okemos, MI 48864
Call Toll Free: (866) 204-0808