WORKERS' COMPENSATION PROGRAM AND ACCIDENT REPORTING POLICY.
Royal School District is "self-insured" for our Workers Compensation Program through the Educational Service District No. 105 in Yakima.
If you are reporting an accident, please follow these procedures:
- Immediately report the injury to your supervisor.
- Complete an Incident Report Form and send to Lara at the District Office.
If you are reporting an injury and will be seeking medical attention, please follow these procedures:
- Immediately report the injury to your supervisor.
- If the injury is non-life threatening, you must go to the District Office to complete the "SIF2 - Self Insurer Accident Report Form" This form must be completed in the District Office it cannot be taken with you. At this time you will be given a copy of the SIF2 form, along with your claim number for treatment.
- If you have a serious injury, please go directly to the hospital; request that the hospital call and we will submit the claim number to them. You will need to follow up with the above paperwork.
- Complete your part of the Physician Initial Report and have physician mail to:
ESD 105
WORKERS COMPENSATION
33 SOUTH 2ND AVENUE
YAKIMA, WA 98902
Please do not use the State Fund (Labor and Industries) State of Washington form at the doctor's office and/or hospital. The Self Insurer Accident Report Form (SIF 2) is your request for benefits. There is NO OTHER SOURCE for your CLAIM request. The SIF 2 is the most important form in the process, and your responsibility. This is imperative if the claim is to be processed properly and in a timely manner.
FORMS:
CONTACTS:
District Claims Coordinator: |
ESD 105 Workers Compensation
Adjudicator/Insurance Accountant: |
Lara Snyder |
Mareli Drakes |
509-346-2222 |
509-454-5316 |
Ext. 4004 |
|
Fax: 509-346-8746 |
Fax: 509-575-2018 |
lsnyder@royalsd.org |
drakes@esd105.org |