Work-Related Injury or Illness
Injuries or Illnesses are considered to be work-related if they arise out of, or during the course of your employment.
The Workers’ Disability Compensation Act establishes the system used to provide wage replacement, medical, and rehabilitation benefits to employees who suffer a work-related injury or illness. If you are injured or become ill because of your job, you may be entitled to Workers’ Compensation benefits.
File your claim
Notify your supervisor about an injury or illness resulting from your work immediately.
File a claim online. Once you file a claim, you’ll get an Event Number to help track your claim.
If you are unable to file online, print out a claim form that can be mailed, faxed, or emailed to our office.
Submit Form: Authorization to Release Patient Information
Work Connections services are designed to provide you with assistance in managing your disability and safe return to work. While completion of this form is optional, by authorizing Work Connections to obtain your medical information, you enable us to meet certain university requirements in order to expedite payment of sick time or other benefits. In addition, developing a relationship with your treatment team and obtaining complete medical information is critical to coordinating an effective plan to help you.
You are responsible for providing sufficient medical documentation to support absence due to disability. Work Connections provides assistance by identifying what medical documentation is needed. As a courtesy, with authorization from the employee, Work Connections will request it from providers on your employee’s behalf. If a treatment provider is non-cooperative, Work Connections will notify you and your employer that our efforts to obtain medical documentation on the employee’s behalf have been unsuccessful.
- Complete this form in its entirety.
- Specifically name each doctor, hospital or medical facility that provides you with medical care.
- If you choose to restrict access to specific medical information, check only those areas that apply. DO NOT check any boxes if you choose not to restrict authorization.
- Understand that restricting Work Connections’ ability to obtain necessary medical documentation may limit our ability to assist you.
- Print the form.
- Sign and date the form.
- Return the signed form to Work Connections via email, fax, or U.S. Mail.
Submit Form: Mileage Reimbursement Form
Employees requesting reimbursement for mileage associated with medical treatment necessary for a work-related injury or illness may use this form.
The Mileage Reimbursement Form can be completed and submitted entirely online. If you prefer, print the form and send it to Work Connections via email, fax, or U.S. Mail.
Online Form Download Form