RESPONSIBILITY OF INJURED EMPLOYEE - 2581.1

(Revised: 12/2013)

The employee shall:

Read and understand the workers’ compensation posters, pamphlets, brochures, and forms provided by the department.

Report all incidents, illnesses, and accidents promptly.

Complete the State Fund e3301.and return to the department to pursue a workers’ compensation claim.

Obtain first aid for minor injury.

Seek medical treatment at the posted provider unless a personal physician has been pre-designated in writing (and the physician agreed) before the date of illness or injury.

Provide State Fund and the department with copies of medical notes or reports received from the treating physician. These notes/reports contain information regarding the employee’s ability to work including any restrictions which must be considered by the department.

Maintain contact with the department and return to work as soon as it is medically feasible.

Submit medical substantiation for all time lost due to the work-related illness or injury