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UBIC

1-800-289-4502

INJURED WORKERS HOTLINE

Available 24 hours

WHEN AN EMPLOYEE IS INJURED ON THE JOB

YOU MUST PROCEED WITH THE FOLLOWING:

1)      Contact preferred urgent care facility by telephone prior to sending injured worker.

a)      Advise urgent care you have an injured worker coming and you are with Utah Builders Insurance and S & C Claims Services.

b)      Advise urgent care you require a mandatory drug test.

2)      a)   Have the injured worker fill out the Injured Worker Statement and sign the Medical Release Form prior to going to urgent care, unless there is a medical reason why this can’t be accomplished, such as bleeding, extreme pain, etc.

b)      If an injured worker is seriously injured and needs immediate care or is transported by ambulance, you must have someone take an injury packet to the medical facility and have it completed as soon as possible.

c)      The injured worker must return it to your office after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.

      THIS IS VERY IMPORTANT!!

3)      If there is a serious injury, notify S & C Claims Services immediately by telephone at 1-800-289-4502. If not serous, collect completed Supervisor’s Report from the injury packet, fill out Form 122 (correctly and completely), put all injured worker’s papers, including return to work/disability slip from doctor, in the injury packet and mail to S & C Claims Services as soon as possible. This must be WITHIN SEVEN (7) WORKING DAYS OF THE INJURY!!

Form 122 is the most valuable tool in a workers compensation case. It must be filled out correctly and completely and faxed to S & C Claims Services IMMEDIATELY at 1-702-876-5584 with a follow-up phone call to ensure S & C Claims Services received the fax on the date the injury occurred. Form 122 must then be mailed to S & C Claims Services as stated above in paragraph 3.

NOTE!! A strong fine may be levied against your company by the Labor Commission if Form 122 is not submitted to S & C Claims Services within seven (7) working days from the date of injury.

Fill out OSHA 300 Log (if necessary). The instructions are in the injury packet!!

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UTAH BUILDERS INSURANCE COMPANY

BUILDERS INSURANCE