Worker's Compensation

Complete Workers' Compensation Packet

Supervisor Responsibilities

1. Complete “First Report of Injury” form and “Agency Claims Investigation” form, and immediately send to Human Resources.
2. Have employee sign “Workers’ Compensation Leave Supplement” form and “Workers’ Compensation Program Department of Employee Relations Information and Privacy Statement” form.  Immediately send both forms to Human Resources.
3. If employee requires medical care, send them to the Winona Clinic in Winona or Olmstead Medical Center in Rochester.
4. Employee should take the “Report of Work Ability” form and “CorVel Corporation Minnesota Certified Workers’ Compensation Manager Care Plan” form to the doctor.
5. “Report of Work Ability” form and/or doctor’s statement must be returned to Human Resources.

Forms

• First Report of Injury
• Agency Claims Investigation
• Information and Privacy Statement
• Leave Supplement
• Notice of Enrollment in a Certified Managed Care Plan for Injuries and Illness
• Corvel Corporation Managed Care Plan
• Report of Work Ability

Related Link

• DOER Worker's Compensation Website