Report an illness or injury

The following forms may be used to report an illness or injury for workers’ compensation (search VCU HR forms). 

  • Accident Report Form 
  • Physician Selection Form 

Use the checklists below for help with the workers' compensation process or print the Workers' Compensation Employee Checklist or the Workers' Compensation Supervisor Checklist available under HR guidelines and user guides. For questions regarding the process, contact the VCU Human Resources Workers’ Compensation office at workcomp@vcu.edu or (804) 828-1533. 

Checklist for reporting an illness/injury

Initiating a claim

  • Report injury/illness to supervisor immediately.
  • Seek immediate medical treatment, if an emergency.
  • Complete Accident Report Form and give to supervisor to complete as soon as possible (see VCU HR forms).
  • Complete Physician Selection Form and seek medical treatment from selected panel physician – not your primary care physician (PCP) (see VCU HR forms).
  • Forward completed forms to VCU Employee Health Services within 24 hours of accident.
  • Follow department call-in procedures.
  • Keep your supervisor informed of absences, work restrictions, or job modifications.
  • Follow-up with panel physician as needed.
  • VSDP participants: contact VCU Leave Administration at 828-1712 and Reed Group (third-party administrator) at 1-888-827-3847 after 7 calendar days of disability.

While your claim is open

  • Communicate work restrictions and medical progress with VCU Workers’ Compensation Office.
  • Keep follow-up appointments with panel physician.
  • Accept recommended treatment by panel physician.
  • Inform supervisor of absences and work restrictions.
  • Review and sign WC agreement forms.
  • Forward medical bills to WC Office for payment.
  • Report all medical appointments and physical therapy visits to WC Office.
  • Complete blue benefits claim form provided by Virginia Workers’ Compensation Commission.
  • Comply with work restrictions recommended by panel physician.
  • Accept modified duty or transitional employment offered.
  • Submit completed Request for FMLA (Family and Medical Leave Act) form to your supervisor – if your injury has resulted in a “serious health condition” or you have missed more than 3 days from work.

Questions?

Workers’ compensation claims management:
VCU Workers’ Compensation Office, 804.828.1533 or workcomp@vcu.edu.

Claim determination, medical authorizations, billing:
Managed Care Innovations (MCI), 804.649.2288.

Medical issues, work restrictions:
Panel physician or Employee Health Services, 804.828.0584.

Leave:
Department timekeeper or VCU Human Resources Leave Administration, 804.828.1712.

The manager's role in Workers' Compensation claims

Helping an employee initiate a claim

  • Report unsafe work conditions or safety hazards to the Office of Environmental Health and Safety.
  • Inform your employee to complete the VCU Accident Report and Physician Selection Forms immediately.
  • Complete in detail the supervisor's section of the Accident Report Form.
  • Forward both completed forms to VCU Employee Health Services within 24 hours of accident.

Investigating the accident

  • Investigate the accident promptly.
  • Contact the Office of Environmental Health and Safety to assist in follow-up prevention efforts.
  • Determine ways to prevent future accidents.
  • Counsel employee on proper safety standards.

While the claim is open

  • Communicate with employee on his/her progress and work modifications.
  • Communicate with Workers' Compensation Office concerning employee's progress.
  • Provide employee with Request for FMLA (Family Medical Leave Act) form to complete if injury or illness resulted in a "serious health condition" or he/she has missed more than 3 days from work.
  • Ensure that employee follows work restrictions recommended by panel physician.
  • Seek modified or transitional duty assignments if needed by employee.


Questions?

Workers’ compensation claims management: 
VCU Workers’ Compensation Office, 804.828.1533 or workcomp@vcu.edu.

Claim determination, medical authorizations, billing:
Managed Care Innovations (MCI), 804.649.2288.

Medical issues, work restrictions:
Panel physician or Employee Health Services, 804.828.0584.

Leave:
Department timekeeper or VCU Human Resources Leave Administration, 804.828.1712.