All employees (e.g., part-time, full-time, or student employees) must report their injury, in writing, immediately but no later than ten (10) working days after the injury. Injuries are to be reported to your supervisor and NSU's Workers' Compensation Manager Finance using the Worker’s Claim for Compensation (WC 15) form. If you were injured more than ten (10) days ago, you should still notify your supervisor and NSU's Workers' Compensation Manager Finance in writing as soon as possible.
File the Worker's Claim for Compensation (WC 15) with the Division within two years of your injury.
Contact NSU’s Workers' Compensation Manager Finance, or the NSU Program Director (Colorado) to get a designated provider list of up to four doctors or clinics, who can provide you treatment. You must select one doctor [Authorized Treating Physician (ATP)] from the designated provider list who will be your doctor for your claim. You must receive the written list within seven business days of you notifying NSU about your injury.
You have the right to make a one-time change to any doctor on that list within 90 days of your injury. You may also complete a Request for Change of Physician (WC 197) to change to another doctor at any time. The insurance carrier may deny your request to change your doctor.
An independent contractor is not typically covered. Supervisors should check with NSU's Workers' Compensation Manager Finance if a contractor reports an injury.
Seek medical care at the nearest hospital immediately.
Mileage and parking related to medical visits and to pick up medications or supplies related to the injury are reimbursable. Mileage must be submitted 120 days after incurred and paid within 30 days.
Please refer to HR's policy at https://www.nova.edu/hr/policies/Colorado%20Employee%20Policy%20Manual%20Supplement%20.html?
TPA: Gallagher Bassette Services, Inc. - Client # 003425-ARCH WCC
Gallagher Bassette Services, Inc.
Medical Billing - P.O.Box 2831, Clinton, IA 52733-2831