Private Supervisor

What to Do in Case of a Work Injury

PREPARE MEDICAL AUTHORIZATION. Form GWC-101A/B Authorization for Medical Examination and/or Treatment, should accompany the injured employee to medical treatment center when obtaining initial medical treatment unless it is an emergency situation. This form must be FULLY COMPLETED to ensure billing is correctly routed. Supervisor must issue ONLY the initial (first) authorization. Insurance carrier will then be responsible for all subsequent authorizations, thereafter, if required.

Supervisor must instruct the injured employee NOT to utilize his or her personal health insurance when obtaining medical care for the occupational injury or illness.

Supervisor must PROVIDE THE EMPLOYEE WITH Form GWC-201 Notice of Employee’s Injury/Illness or Death or you may use your own incident report forms.

Supervisor must COMPLETE Form GWC-202 Employer’s Report of Occupational Injury or Illness and file with WCC within TEN (10) calendar days from the date of the accident or when supervisor first become aware of the injury. The date supervisor obtained knowledge of the accident/injury will be “Day One (1)”. Failure to file this report in a timely manner may subject your office to penalties amounting to $500.00 for each failure or refusal to file such report. Therefore, if the employee chooses NOT to seek immediate treatment, supervisor must indicate on Form GWC-202 that employee refused medical treatment.

Doctor’s Certification needed for:

  • Injury causing the employee to return to work but on a limited or restricted status, for example, light duty.
  • Injury causing employee to be off from work.
  • Employee to return to regular duty fit for work.

IMPORTANT: A copy of these reports along with any and all medical documents received from the employee MUST be provided to insurance carrier so as to properly facilitate the claim.

WARNING: Misrepresentation of facts in order to obtain or evade liability of WC benefits shall be guilty of a misdemeanor.