Author: smagney

Claims Reporting: Supervisor’s Duties

1. REQUIRE THE EMPLOYEE to complete an Employee Incident report form and then call to report the injury to NEWESD 101 Claims Service IF the employee will be seeing a medical provider.
2. COMPLETE Part 2 of the Employee Incident Report form, send the completed report to the district office, AND fax the report to NEWESD 101 at (509) 789-3780.
3. INVESTIGATE THE ACCIDENT SITE IMMEDIATELY.
4. WHAT TO DO IF THE EMPLOYEE NEEDS TO SEE A MEDICAL PROVIDER:
Provide the employee with a copy of this brochure.
See #5 under Claims Reporting: Injured Employees Responsibilities.
Have the employee contact you immediately after the doctor visit.
Require the employee to provide you with a copy of the Return to Work status note within 24 hours after EACH doctor visit.
Contact NEWESD 101 Claims Services immediately to:
Report the employee has gone to a medical provider
Provide details of your investigation to the claims services staff
5. WHAT TO DO AFTER THE EMPLOYEE RETURNS FROM THE DOCTOR’S OFFICE:
Review the Return to Work status note to identify if there are restrictions and if there is light or modified duty available.
Fax the note to the NEWESD 101 Workers’ Compensation Claims Department at (509) 789-3780.
Contact the NEWESD 101 Claims Department at (509) 789-3516 immediately to report…
Employee has returned to full-time regular work without restrictions, OR
Employee has returned to working regular hours with restrictions, OR
Employee has returned to light modified work with restrictions, AND
The start date, scheduled hours, wage, and description of the light modified duties.
Be sure to also forward the above information to your District Office.

Early Return to Work - Importance of Light Duty

Part of a cost effective workers’ compensation system is a return to work program which enables injured workers to maintain their full wages while performing
temporary, less physical tasks while they recover.
When released by their doctor, it is possible to do work outside their regular tasks,
or department, which helps them recover, build strength, and maintain income.
Our claims adjusters will work with member school districts to see what light duty opportunity exists or can be provided. Rev 08/2022

Northeast Washington Workers’
Compensation Cooperative

Northeast Washington ESD 101 (NEWESD 101) operates the Northeast Washington Workers’ Compensation Cooperative to provide industrial insurance benefits to 58 public school districts in Northeast Washington. The cooperative pays for approved medical, hospital, and related services due to workplace injuries. In addition to claims services, the cooperative also provides environmental, health, security, industrial safety, and risk management to member districts.

CONTACT INFORMATION EMPLOYEE CLAIMS SERVICES
Ben Gagne, Claims Adjudicator
(509) 789-3515
bgagne@esd101.net
Jennifer Pritchett, Claims Adjudicator
(509) 789-3520
jpritchett@esd101.net
Laura Prawdzik, Claims Assistant
(509) 789-3519
lprawdzik@esd101.net
Krista Hartman, Claims Assistant
(509) 789-3516
khartman@esd101.net
Unsure who your claim manager is? Please call Laura or Krista for assistance .
ENVIRONMENTAL / HEALTH / SAFETY SERVICES
Don Ebert, Risk Manager
(509) 789-3517
debert@esd101.net
Jerry Page, Industrial Hygienist
(509) 789-3518
jpage@esd101.net
Kassidy Probert Asst. Superintendent
Operations and Technical Services
Rob Roettger, Superintendent

WHAT IS NEWESD 101? At NEWESD 101 we are proud to serve and support 59 public school districts and 45
state-approved private schools in seven counties in eastern Washington (Adams, Ferry, Lincoln, Pend Oreille, Spokane, Stevens, and Whitman). We promote educational excellence by delivering essential, cooperative services to schools and other learning communities.
NEWESD 101 is the state’s largest ESD in the number of districts served and geographic region served, 14,026 square miles. All told, the region counts more than 100,000 K-12 students and 257 individual school buildings.
WHAT IS WORKERS’ COMPENSATION INSURANCE? Workers’ compensation, provides no-fault industrial insurance benefits to employees of member districts who are injured in the course of their employment or develop an occupational disease as a result of their required work activities.

Northeast Washington Workers’ Compensation Cooperative

Environmental, Health, & Safety

Claims Reporting: Injured Employee’s Responsibilities

NEWESD 101 assists member districts with
identification, guidance and prevention methods to environmental, health, and safety training
issues that may impact a district, school, or employee.
These services include...

Accident Investigations
Accident Prevention Program & Manual
Asbestos Consultations
Back injury prevention
Confined Space
CPR & First Aid Trainings
Ergonomic Evaluations
Facility Safety Reviews
Fall Prevention
Fire Prevention
Hazardous Waste Disposal
Health & Safety Risk Assessments
Incident & Claims Loss Control Investigations
Indoor Air Quality Investigations
L&I Compliance Assistance
Ladder Safety
Lock Out Tag Out
Noise Level Measurements
On-Site, Phone & Email Consultations
Personal Protective Equipment
School Safety Manager Training
Safety Seminars & Trainings

SEEK FIRST AID OR MEDICAL ATTENTION IF NEEDED.
2. INFORM YOUR SUPERVISOR IMMEDIATELY.
3. COMPLETE AN EMPLOYEE INCIDENT REPORT FORM.
An employee incident may not require professional medical attention or workers’ compensation benefits; however, all employee incidents need to be recorded so facts of the injury, or near-miss, can be gathered to prevent future incidents and reduce workplace hazards.
4. WHAT IF I GO TO A MEDICAL PROVIDER?
Contact NEWESD 101 at (509) 789-3516 or (800) 531-4290 to report the incident by providing details to the claims staff and obtain a claim number. Inform your medical provider that your injury is a work related incident.
Please note: You are able to see any physician of your choice for your initial visit. However, if you require additional medical care, your attending physician must be enrolled in the L&I medical provider network. You can check your provider's network status at www.FindADoc.Lni.wa.gov.
5. WHAT DO I TELL THE MEDICAL PROVIDER?
Provide the medical provider with your claim number.
If you do not have a claim number, call NEWESD 101 at your earliest convenience.
Instruct the medical provider to forward all information to: NE WA Workers’ Compensation Cooperative
4202 South Regal Street
Spokane, WA 99223
Phone (509) 789-3516
Fax (509) 789-3780
Complete the Patient Information Section on the Physician’s Initial Report (PIR) provided by the doctor’s office.
DO NOT FILE AN L&I STATE FUND CLAIM FORM.
Obtain a note with your work status from the attending physician. Please advise NEWESD 101 Claims Department if you will be missing time from work.
Schedule a return appointment.
6. WHAT TO DO AFTER EACH MEDICAL PROVIDER VISIT.
Call or fax NEWESD 101’s Claims staff to report your work status. Phone (509) 789-3516, Fax (509) 789-3780.
Report your return to work status to your supervisor immediately.
Provide your supervisor & NEWESD 101 a copy of your work status. note.