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City of Memphis Injury On Duty (IOD) Attending Physician Form & Physical Therapy Note Medical Facility: Front Desk Initials: Date: / / Time In: Time Out: (To be completed by Employee) EMPLOYEE.

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you have the right to file a claim for your injury or illness in workers compensation court or the state industrial court. you have the right to see a doctor and to pursue medical treatment. if you are released to return to work by your physician, you have the right to return to your job.

The official form that needs to be completed is W.Cl 2 - Notice of Accident and Claim for Compensation. This form should be completed whenever an employee meets with an accident out of or in course of employment that leads to personal injury or where medical treatment is required or in the case of death.

If the employee is booked off due to an IOD for 4 days or longer, but less than 3 months, the employer must pay the injured employee at a rate of at least 75% of his earnings, from the first day, until the employee returns to work. Please note that earnings are not only the basic salary of the worker.

To get compensation, you must provide written or verbal notice of the accident to your employer as soon as possible and may also provide notice to the commissioner of the compensation fund. When reporting the accident, you must provide any documents, information, medical reports or other documents concerning the claim.

Payment criteria three: If the employee is booked off due to an IOD for a period longer than 3 months, the employer pays the injured employee at a rate of least 75% of the workers earnings, for the first 3 months. Once the 3 month period expires, the injured employee must claim his money from the Compensation Fund.

Pictures of the scene and your injuries. Witness reports. Time reports showing that you were clocked in at the time of the accident. Maintenance reports of equipment involved in the accident. Documentation from your doctor.

Reporting the Injury to Your Employer Make it clear that you were hurt on the job. Some state laws simply say that you should give this notice immediately or as soon as practical, but most states give a more specific deadline, usually within 10 to 90 days.

Injury on duty. Compensation of Occupational Injuries and Diseases Act. Means an accident arising out of and in the course of an. Employee's employment and resulting in personal injury, illness. or the death of the employee.

According to the COIDA definition it means ''an accident arising out of and in the course of an employee's employment and resulting in a personal injury, illness or the death of the employee''. In order for the worker to claim, the accident should ''arise out of and in the course of an employee's employment''.

dial 999 or 112 as soon as possible and ask for an ambulance. treat any obvious injuries. lie the person down if their injuries allow you to and, if possible, raise and support their legs. use a coat or blanket to keep them warm. don't give them anything to eat or drink.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232