Employee Accidents and Injuries - File a claim
The Everett School Board recognizes that safety and health standards should be incorporated into all aspects of the operations of the District. Your safety is important to us.
If you are injured at work, you are required to submit an Accident/Incident Report whether you seek medical care or not. You must report your accident/injury to your supervisor, the Human Resources Department and Puget Sound Workers' Compensation Trust immediately.
The Puget Sound Workers’ Compensation Trust is the third-party administrator managing the District’s employee Accident/Incident Reports and work injury claims.
Accident/Incident Report forms are submitted via computer online directly to the Puget Sound Workers' Compensation Trust. If you do not have access to a computer, contact your supervisor or the Human Resources Department for assistance. Once your report is received by the Puget Sound Workers’ Compensation Trust, it will be sent to your supervisor for review and investigation of the incident or accident.
If you indicated on your Accident/Incident Report form you have or are planning to seek medical treatment for your injury, your report will automatically become a work injury claim. Once your online report and work injury claim is successfully submitted, you will be issued and emailed a work injury claim number by the Puget Sound Workers’ Compensation Trust. This claim number is to be provided to any doctor who treats you for the work injury. Tell your medical provider that your injury was an on-the-job injury.
Submitting your claim and obtaining a claim number before seeking medical treatment is always best. However, if your injury requires immediate medical attention, submitting your claim and obtaining a claim number may be done after treatment is received.
Upon submitting your Report and work injury claim, the Puget Sound Workers’ Compensation Trust will email you the following:
- Your claim number (give this number to your doctor/medical provider)
- Medical Cards (for treatment, services and/or to purchase any medical equipment you may need)
- Prescription Letter (to fill/pay for any prescriptions from your medical provider)
- General work injury claim information
When submitting a work injury claim, also contact the HR Benefits department to discuss your status and next steps. If you are off for any amount of time related to your work injury claim, you are required to complete a a time loss election form, which must be requested from HR Benefits, completed by you and then submitted back to the HR Benefits department within 7 days of injury date. The HR Benefits department will review this required form with you, as your elections will directly impact District pay and may impact your medical benefit eligibility. All completed forms can be faxed to 425-385-4135.
You may choose your own doctor/medical provider for your first treatment visit However, ongoing treatment of your injury must be from a State approved Occupational Medical Provider.
It is extremely important that employees submit a copy of the completed Activity Prescription Form (or whatever paperwork the medical provider gives you) to Human Resources immediately after receiving treatment and following every appointment. This document can be faxed to the benefits office at 425-385-4135, scanned and emailed to firstname.lastname@example.org or brought to Human Resources in the CRC Building at 3900 Broadway, Everett.
If you have general questions regarding workers' compensation benefits, please read A Guide to Workers' Compensation and Benefits. For specific claim questions after filing, please contact your claims adjustor with Puget Sound Workers' Compensation Trust at 253-778-7667.
IMPORTANT DISTRICT CONTACT INFORMATION
Phone: 425-385-4115 Fax: 425-385-4135
Benefits Department/Human Resources
Community Resource Center
3900 Broadway, Everett WA 98201