Workers’ compensation provides medical coverage and, in some instances, income to employees who are disabled as a result of work-related injury or illness. Payment for reasonable and medically necessary medical services, supplies, medication, surgical, and hospital care (as determined by the workers' compensation insurance company) is available at no cost to the employee on approved claims.
Any work-related injury or illness, no matter how minor, must immediately be reported to 1) your supervisor; and 2) Human Resources (484-664-3165 / [email protected]), but in no case no later than 24 hours following the incident. Employees are required to complete a First Report of Injury form. Supervisors are required to complete a Supervisor’s Accident Investigation Report within 3 days of the incident. Each supervisor is responsible for investigating accidents. The purpose of the investigation is to determine the root cause of the incident and implement practical solutions to help prevent recurrence.
Muhlenberg College has an approved healthcare provider panel, and the Pennsylvania Workers’ Compensation Act requires that all Muhlenberg employees treat with providers listed on this panel for 90 days from the first day of treatment for work-related injury/illness. If an employee fails to treat with a panel provider before the 90-day period has expired, Muhlenberg College is not responsible for paying the non-panel provider for services. If you are faced with an immediate/urgent medical emergency, you may secure initial assistance from a hospital, physician, or other health care provider of your choice. You must then seek subsequent treatment from a healthcare provider listed on the approved healthcare provider panel for at least the first 90 days from the date of your first treatment. After the initial 90-day period, if you still need treatment, you may choose to go to another physician/healthcare provider for treatment. If this situation should arise, let Human Resources and your insurance claim representative know within five days of the first visit.
Workers’ compensation fraud is a crime, subject to criminal and civil penalties. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
Forms available are created in PDF formats, which require Adobe Acrobat Reader to display. If you do not have this product, please click on the Adobe icon below to install a free copy:
The forms listed below should be completed promptly and returned to Human Resources, Haas Building, 3rd Floor. Please call with any questions: 484-664-3165.
- Email: [email protected]
- Fax: 484-664-3910
Workers' Compensation Employee Forms
Incident Investigation Report - Supervisor
For the Physician: