Workers' Compensation Benefits:
Worker' Compensation in Nebraska is designed to provide certain benefits to employees who sustain injury by accident or occupational disease arising out of and in the course of their employment, and who are not willfully negligent at the time of the injury. Your Rights and Obligations Under the Work Comp Law
Employee health and safety are a priority of the Department of Health and Human Services. It is important that all employees follow safety procedures and bring potential hazards to the attention of their supervisor to avoid employee accidents and injuries.
In spite of this, accidents may still occur. When they do, IMMEDIATELY:
Notify your supervisor and fill out or cooperation in filling out the Employee Injury Incident Report
before the end of your work shift and send to DHHS.myHR@nebraska.gov
before the end of your work shift. Failure to report the injury/illness immediately may result in denial of worker's compensation benefits.
- PLEASE NOTE: IF YOU DO NOT PLAN ON SEEKING MEDICAL TREATMENT, YOU ONLY NEED TO COMPLETE THE EMPLOYEE INJURY/INCIDENT REPORT. IF YOU DO PLAN ON SEEKING MEDICAL TREATMENT, YOU WILL NEED TO COMPLETE THE ENTIRE PACKET.
Included in packet:
Employee Injury/Incident Report – complete all portions of this form (Return to HR)
Witness Statement- Give to all who saw the accident (Return to HR)
Choice or Change of Doctor Form (Return to HR)
Authorization for Release of Information (Return to HR)
Acknowledgment and Agreement When Workers’ Compensation is Determined Compensable(Return to HR)
Return to Work Recommendations (RTW) – Must be completed at each medical appointment and returned to the Workers’ Compensation Coordinator no later than 24 hours after the appointment. Return to Work Recommendation sheet
First Script Form – You will take this with you when filling a prescription for your injury
The Workers' Compensation Process:
The Worker's Compensation Process document will explain how to submit medical bills, time sheets, and the Return to Work Forms.
Occasionally, you may need to seek outside medical attention or miss some work. If you don’t have a regular physician and need to seek medical attention due to a work-related injury, your supervisor and/or worker’s compensation coordinator will provide you with a list of authorized providers.
The goal is to get you back to a productive work status as soon as possible, and to help maintain your well-being, your salary and benefits.
Supervisors: for more information, email Human Resources, Attn: Workers' Comp Coordinator, at DHHS.myHR@nebraska.gov.