{"id":848,"date":"2022-06-06T20:35:01","date_gmt":"2022-06-06T20:35:01","guid":{"rendered":"https:\/\/web.tarleton.edu\/safety\/?page_id=848"},"modified":"2025-05-09T16:51:49","modified_gmt":"2025-05-09T16:51:49","slug":"forms-and-resources","status":"publish","type":"page","link":"https:\/\/www.tarleton.edu\/safety\/works-compensation\/forms-and-resources\/","title":{"rendered":"Forms and Resources"},"content":{"rendered":"\n

Workers’ Compensation Forms and Resources<\/h1>\n\n\n\n

Forms<\/h2>\n\n\n\n

Notice to Healthcare Providers of Workers’ Compensation Insurance Coverage<\/a><\/p>\n\n\n\n

Notice of Injured Employee Rights & Responsibilities in the Texas Workers’ Compensation System<\/a><\/p>\n\n\n\n

Request for Paid Leave<\/a><\/p>\n\n\n\n

Wage Statement<\/a><\/p>\n\n\n\n

Supplemental Report of Injury<\/a><\/p>\n\n\n\n

<\/div>\n\n\n\n
\n

Resources<\/h2>\n\n\n\n

System Policy 24.01, Risk Management<\/a><\/p>\n\n\n\n

System Administrative Procedure and Management Standard Guide<\/a><\/p>\n\n\n\n

Early Return to Work Program<\/a><\/p>\n\n\n\n

Origami Incident Entry Guide<\/a><\/p>\n<\/div>\n\n\n\n

<\/div>\n\n\n\n

Your health care provider, emergency room, or pharmacy may request billing information regarding your workers’ compensation claim. For these purposes, provide the following information to your treating physician or pharmacist:<\/p>\n\n\n\n

Texas A&M System, Office of Risk Management<\/strong>
301 Tarrow Street, 5th<\/sup> Floor
College Station, TX 77840-7896
Phone: 866-249-8574; 979-458-6330
Fax: 979-458-6247<\/p>\n\n\n\n

Note: Supervisors note that absences due to work-related injuries may also fall under the provisions of The Family and Medical Leave Act (FMLA). Proper FMLA procedures must be followed.<\/p>\n","protected":false},"excerpt":{"rendered":"

Workers’ Compensation Forms and Resources Forms Notice to Healthcare Providers of Workers’ Compensation Insurance Coverage Notice of Injured Employee Rights & Responsibilities in the Texas Workers’ Compensation System Request for …<\/p>\n","protected":false},"author":62,"featured_media":580,"parent":843,"menu_order":2,"comment_status":"closed","ping_status":"closed","template":"template-fullwidth.php","meta":{"_acf_changed":false,"inline_featured_image":false,"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","footnotes":""},"class_list":["post-848","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"coauthors":[],"author_meta":{"author_link":"https:\/\/www.tarleton.edu\/safety\/author\/kyle-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-2-3\/","display_name":"kyle"},"relative_dates":{"created":"Posted 4 years ago","modified":"Updated 12 months ago"},"absolute_dates":{"created":"Posted on June 6, 2022","modified":"Updated on May 9, 2025"},"absolute_dates_time":{"created":"Posted on June 6, 2022 8:35 pm","modified":"Updated on May 9, 2025 4:51 pm"},"featured_img_caption":"","featured_img":false,"series_order":"","_links":{"self":[{"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/pages\/848","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/users\/62"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/comments?post=848"}],"version-history":[{"count":2,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/pages\/848\/revisions"}],"predecessor-version":[{"id":1739,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/pages\/848\/revisions\/1739"}],"up":[{"embeddable":true,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/pages\/843"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/www.tarleton.edu\/safety\/wp-json\/wp\/v2\/media?parent=848"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}