NOTICE TO
EMPLOYEES IN CASE OF WORK-RELATED INJURY
If you suffer a work-related injury, in the course of your
employment, report it to your supervisor and CTA's Benefits Administrator
immediately. Chris TALARICO & Associates, Inc. (the “Company”) shall
provide payment for reasonable surgical and medical services, services rendered
by physicians or other health care providers, medicines and supplies, as and
when needed, in accordance with the Workers Compensation Act of Pennsylvania.
According to the Act, for your medical treatment to be paid
by the Company or the Company’s worker’s compensation insurance carrier, you
are required to visit one of the physicians or healthcare providers designated
below and continue to visit the same or another physician or healthcare provider
for a period of 90 days from the date of the first visit. Should you choose to
not follow these guidelines, the Company will be relieved from liability for the
payment for the services rendered during the applicable period. Should your
injuries require emergency treatment you should visit the emergency room of your
choice. However, you must report the injury to your supervisor and to CTA's
Benefits Administrator within 24 hours. He/she will make future referrals for
follow-up treatment within the referral network.
After the 90 day period mentioned above, treatment may be
provided by any healthcare provider of your choice, provided you notify the
Company, through our Benefits Administrator, in writing within 5 days of the
first visit to a healthcare provider who is not designated below. Failure to do
so will relieve the Company from liability for the payment for the services
rendered prior to the appropriate notice if such services are determined to have
been unreasonable or unnecessary.
Any provider who treats an injured staff member shall be
required to file periodic reports with the Company or its insurance carrier, on
a form prescribed by the Department of Labor which shall include, where
pertinent, history, diagnosis, treatment prognosis and physical findings. The
report shall be filed within 10 days of starting treatment and at least once a
month thereafter, as long as treatment continues. The Company shall not be
liable to pay for such treatment until a report has been filed.
IN ORDER TO RECEIVE BENEFITS YOU MUST:
- TELL
THE TREATING FACILITY THAT YOU HAVE A WORK RELATED INJURY
- TELL
THE TREATING FACILITY THAT YOU ARE AN EMPLOYEE OF CHRIS TALARICO & ASSOCIATES,
INC.
- TELL
THE TREATING FACILITY THAT YOU ARE NOT AN EMPLOYEE OF OUR CLIENT.
- CALL
US AND TELL US ABOUT YOUR INJURY AS SOON AS POSSIBLE
Chris TALARICO &
Associates, Inc.
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