Resources

• Guidelines/Recommendations

  Guidelines/Recommendations

  Workers' Compensation Guide

  This guide features an overview of workers’ compensation and what steps you should take as the employer of an injured worker. It gives insight to the responsibilities of employers and our staff to successfully handle each claim.

• Screening Tools

  Screening Tools

  1020 Form: Employee Monthly Report of Earnings

  This form is required by all employees receiving workers’ compensation benefits in the state of Louisiana for supplemental earning benefit claims. The 1020 form should be submitted on a monthly basis to report the claimant’s previous month’s earnings.

• Screening Tools

  Screening Tools

  First Fill Pharmacy Card

  The Carlisle Medical Pharmacy Card is provided to each injured worker for the convenience of obtaining prescriptions related to their work injury.

• Assessment tools

  Assessment tools

  Employee Interview Form

  This form assists the employer in documenting vital information as it relates to the employee’s injury. With questions specific to the incident, the injury and the employee, this form was designed to help create a clear understanding of the employee’s claim.

• Assessment tools

  Assessment tools

  First Report of Injury or Illness (FROI) Form

  This form is required by the Office of Workers’ Compensation within 10 days of the incident. Similar to the Employee Interview Form, the FROI form documents the information of the employer, carrier, employee, occurrence and injury.

• Screening Tools

  Screening Tools

  SIB Knowledge Questionnaire

  This form is required by the Office of Workers’ Compensation within 10 days of the incident. Similar to the Employee Interview Form, the FROI form documents the information of the employer, carrier, employee, occurrence and injury.

• Algorithms

  Algorithms

  Work Evaluation Form

  This form should be provided to the treating physician at every visit to provide the employer with a current work status of the injured worker if they have been given restrictions from full duty employment.

• Algorithms

  Algorithms

  Workers' Compensation Mileage Reimbursement Form

  This form should be provided to the treating physician at every visit to provide the employer with a current work status of the injured worker if they have been given restrictions from full duty employment.