Worker's Compensation

To file a claim for Worker's Compensation for an injured employee following are the steps to be taken and the necessary forms:


Please forward all completed forms to the Human Resources Department.

Step 1

This form (above) is to be completed in its entirety by your employer and must be filed within seven (7) calendar days, not including Sunday and legal holidays, or receipt of notice of any injury alleged to have risen out of and in the course of employment which incapacitates an employee whether it involves medical care only or from earning full wages for a period of five (5) or more calendar days.

Step 2

Step 3

This form (above) is to be completed and signed by the employee to release medical information to MHC or representative on information relating to the injury.

Step 4

This form (above) is to be completed by your medical provider when medical treatment is provided.