INDIANA UNIVERSITY
BLOOMINGTON CAMPUS
WORKER’S COMPENSATION REPORTING PROCEDURES

Following receipt of medical treatment you will be given a Work Status Report which may list work restrictions which should be followed or may indicate you are to be off work. If the form indicates you are to be off work, contact your supervisor to advise them you will be off work. Otherwise, take this form to your supervisor following the appointment and before you leave campus for evaluation of transitional work that may be available. If transitional work is not available through your responsibility center (e.g. Physical Plant, RPS), your departmental coordinator is required to call the Worker’s Compensation Unit at 855-4847 before you leave campus.

If you choose to seek medical treatment with a physician of your choice, it will not be paid by Worker’s Compensation.

A case manager may be assigned to coordinate your treatment.

We want to make you aware that your Worker’s Compensation benefits may be suspended or terminated for:

1. Failure to comply with medical treatment.
2. Missing a scheduled medical appointment.
3. Refusing to accept transitional duty work assignments.
4. Not contacting the Worker’s Compensation Unit after 24 hours of attempts to contact you at the contact number you provided.
5. Other reasons as defined in the Indiana Worker’s Compensation statute.

It is extremely important that the Worker’s Compensation Unit be able to reach you while you are injured and may be in an off work status. This will allow your medical treatment to be coordinated in an effective and efficient manner as well as letting you know when transitional duty work has been assigned to you.

You can be reached at ________________________________________________.

Your signature below indicates you have read and received a copy of the above.

________________________________Employee Signature _______________Date