How to Process a Claim for Employees


Responsibilities of the Injured Employee

Employees Checklist

A.  Any LSCS employee who suffers an accidental injury or occupational disease as a direct result of and in the course and scope of employment should immediately notify his/her direct supervisor. Failure to report the injury within 24 hours of the occurrence of the injury (or the manifestation of the occupational disease) may result in the denial of the claim.

B.  The employee must complete an Employee Statement of Injury ,and email the completed form to the Office of Risk Management (ORM) within 24 hours of the occurrence of the injury (or the manifestation of the occupational disease).

C.  Employee should immediately contact his/her Senior Human Resource Manager (SHRM) for direction or guidance regarding how LSC benefits, such as leave, FMLA, group health, disability and retirement, etc., are affected by a workers’ compensation claim. Please refer to HR Benefits.

D.  The employee must notify the ORM of any change in income regardless of whether the income increased or decreased. If the employee starts working after a period of lost time, or has been made a bona fide offer of employment, he/she must notify the ORM, even if employment or the offer is not within the LSCS.

E.  If you miss work due to a work related injury, you must keep the LSCS informed of your work status by providing a DWC073, Work Status Report, to the ORM after each doctor visit. The treating doctor’s office must provide the report to you. A DWC073, is required after the initial examination and if you experience a change in work status, a substantial change in activity restrictions, or as requested by the LSCS.

F.  When your treating doctor releases you to return to work, you must report to work at the beginning of your next regularly scheduled shift. The DWC073, report from your doctor indicating a return to work date or any work-related limitations must be given to the ORM before you return. If you are released to return to work with restrictions, you must work with your supervisor and the ORM to comply with any restrictions the physician has indicated on a work status report.

G.  If it is necessary for the employee to change treating doctors for treatment of a work-related injury, the employee must complete a DWC053, Employee Request to Change Treating Doctor and receive written approval from TPS before making the change.

H.  It is the employee’s responsibility to keep their contact information updated within iStar and with the ORM. If home address, work address, or contact phone number changes the employee should notify the LSCS Human Resources (HR) and the ORM.

I.  You must continue communicating with your supervisor and the ORM throughout any period of disability unless physically unable to do so.

J.  Except in an emergency, if the employee receives medical care for a work related injury that is not by or at the direction of the treating doctor, payment of any charges associated with that care may become the responsibility of the employee.



Employees E-Packet (Required Documents)

Employee Statement of Injury
Initial Examination Authorization
PMOA Workers Comp 1st Prescription Fill Card Voucher
Work Status Report (DWC073)
Employee Request to Change Treating Doctor (DWC 053)
Injured Employees Rights and Responsibilities English
Injured Employees Rights and Responsibilities  Spanish
Ombudsman Program Notice English
Ombudsman Program Notice Spanish

Workers' Compensation Identified Medical Provider List


Workers Compensation Program Manual

Workers Comp Standard Forms



For more information, contact the Office of Risk Management (ORM)


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