Workers' Compensation, Office of Budget and Controller

Worker's Compensation

Your Responsibilities

Employee Responsibilities

Immediately provide as much information as you can about your injury or illness to your supervisor or departmental designee. This person will submit the requisite forms to workers' compensation to initiate your claim.

If you require medical treatment, follow the procedures set forth on the Health Care Provider Panel and Procedures.

Sign the Employee Acknowledgement.

Supervisor Responsibilities

Have your employee sign the Employee Acknowledgement. If an employee refuses to sign this document, you may sign your own name and date that employee has reviewed and understands the form but refuses to sign.
Fax the completed Employer’s Report of Occupational Injury or Disease(LIBC 344) (2 pages), Additional Injury Report Information Sheet and signed Employee Acknowledgement to Workers’ Compensation (412-624-1817) within one business day of your knowledge of the incident.
Direct your employees to the Health Care Provider Panel if they require medical attention.
Immediately notify Workers' Compensation if an employee misses at least one day of work because of that injury.
Notify Workers' Compensation when an employee returns to work after a workers' compensation leave.