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Workers’ Compensation Act

WORKERS' COMPENSATION NOTICE THAT

Employer: Brigham Young University
Has complied with the provision of the Workers' Compensation Act, Title §34A-2-101, Utah Code Annotated, 1997 (as amended), and the rules of the Labor Commission, and has insured the liability to pay the compensation and other benefits provided by said Act by insuring with

Insurance Carrier: Risk Management & Safety
Address for the above insurance carrier is 124 TOMH.
And telephone number is (801) 378-4468

WORKERS' COMPENSATION
IS INSURANCE WHICH PROTECTS YOU DURING WORK. IF YOU HAVE AN ON-THE-JOB INJURY OR OCCUPATIONAL DISEASE, IT WILL PAY FOR: HOSPITAL AND MEDICAL BILLS * TIME LOST FROM WORK * PERMANENT LOSS OF BODY FUNCTION * PROSTHETIC DEVICES * BURIAL BENEFITS IN DEATH CASES.

HOW TO REPORT AN ACCIDENT
1. Report the injury - no matter how slight - to your boss immediately. (You may lose your rights if your injury is not reported within 180 days of the injury or work related illness.)
2. Ask your employer to fill out the employer's first report of injury form. a copy of this report is to be given to you and copies are to be sent to the Labor Commission and to the insurance company within seven (7) days of the accident.
3. If your employer has a first aid room or company designated doctor, go there promptly for treatment. If not, go to a doctor of your choice.
4. Tell the doctor HOW, WHEN and WHERE the accident happened. the doctor will fill out a medical report form. copies of the report are to be sent within seven (7) days of your visit to (1) the insurance company, (2) the Labor Commission and (3) you, the employee.

HOW TO START COMPENSATION
1. Ask your employer which insurance company pays workers' compensation for your company.
2. Ask your doctor to send a medical report to that insurance company.
3. Ask your employer to send a report of the accident to that insurance company.
4. Call the insurance company and ask them to start your workers' compensation benefits. The insurance company will require the doctor's report, employer's report, and may ask you to fill out a request for compensation.

REHABILITATION
IF YOU CANNOT RETURN TO WORK, YOU MAY BE ELIGIBLE FOR A REHABILITATION PROGRAM - CALL YOUR INSURANCE CARRIER AS LISTED ABOVE.

FRAUD
"For your protection, Utah law requires the following to appear on this form, any person who knowingly presents false or fraudulent underwriting information, files or causes to be filed a false or fraudulent claim for disability compensation or medical benefits, or submits a false or fraudulent report or billing for health care fees or other professional services is guilty of a crime and may be subject to fines and confinement in state prison."

STATE OF UTAH LABOR COMMISSION

160 EAST 300 SOUTH, PO BOX 146610, SALT LAKE CITY, UT 84114-66120
(801) 530-6800 -- (800) 530-5090 -- 530-7685 TDD

If you want an Employee's Guide to Workers' Compensation or have questions, call the Labor Commission at the above listed numbers.
Note: This notice must be posted and kept continuously in a public and conspicuous place in the office, shop or place of business of the employer as per §A-2-204, Utah Code Annotated, 1997.
Revised 8/12

IMPORTANT CAMPUS TELEPHONE NUMBERS

Equal Opportunity: 1 (801) 422-5895
24-Hour Line: (888) 238-1062
Employee Relations: 1 (801) 422-9065
Risk Management: 1 (801) 378-4468
Campus Security: 1 (801) 422-2222

This poster contains the exact wording of the official government notices obtained from the Utah Labor Commission and the Utah Department of Workforce Services.
BYU Equal Opportunity Office, Updated October 2012

Updated by the HRS Web Team, Brigham Young University, Provo, UT 84602 - Copyright 2008. All Rights Reserved.