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Workers’ Compensation Guide

Third Party Administrator: Gallagher Bassett

Visit Gallagherbassett.com

What do I do when an employee reports an injury?

1. Employee notifies employer as soon as possible but it is recommended to do so within 24 hours and at least within the ten day window allowed by state law.

2. Employee finds an approver facility and receive treatment

3. Employer fills out report of injury OR call Gallagher Bassett and report the injury to them.

Gallagher Basset contact:

New Claims:

Phone: 844-529-8284
Fax: 800-748-6159
Email: tnwclaims@tnwinc.com

Existing Claims:

Phone: 303-796-9494
Fax: 303-796-9498
Loss of Claims: 303-218-7816
Medical Only Claims: 303-218-7830

4. Injury Counselor and Gallagher Basset reach out to employee and employer.

  • The injury counselor is an extension of the Archdiocese of Denver and works with the employee and employer on behalf of the Archdiocese of Denver. They walk with the employee as they are going through the WC process and is there as a resource to the employer as they are filling out forms, exercising employee limitations, and the return to work process.
  • Your WC Injury Counselor can be reached at AODInjuryCounselor@lockton.com

5. If employee is out of work OR employee returns to work with restrictions the AOD Return to Work Policy is followed. Your Injury Counselor will walk you through each step.

Accident Report vs. Employer’s First Report of Injury (ROI)

  • The accident report is used when students, visitors, parishioners, or volunteers have an injury or accident.
  • The employer’s first report of injury is completed for employees who have an injury or accident on the job, therefore is for workers’ compensation.

Notes for Business Managers (BM)

  • The Injury Counselor will be reaching out to the BM asking for a copy of the employee’s job description and last ten weeks of pay data. It is imperative that the BM provide the information to the Injury Counselor ASAP.
  • Upon Employment: Employee’s receive a copy of the signed Employee Notification Form and Designated Providers approved by the Archdiocesan WC plan.
  • Employee Notification Form WC 2021-2 PDF
  • Employer’s First Report of Injury (ROI): Keep copies on file should you need to have the physical form handy depending on the injury location to gather needed information. The forms can be translated into the website pdf fillable form immediately afterwards if desired.
  • Designated Medical Providers: Keep copies on file to provide employees upon injury.

Step 1 –  Have the employee fill out the Employer’s First Report of Injury if they are able. Otherwise, fill this out on their behalf within 24 hours of the injury, even if all the information isn’t available. ALL INCIDENTS should be reported, no matter how small. If in doubt, report the injury.
Step 2 – Send First ROI to Gallagher Bassett email contact above.
Step 3 – Gallagher Bassett will be in contact with you and the employee with any subsequent next steps needed.
Step 4 – File First ROI according to the retention schedule and proceed to follow-up with employee in good-will.

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