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When an employee is injured on the job, proceed with the following:

  1. Complete the First Report of Injury (Form 1A-1), providing details of the accident and injury.
  2. Complete the Wage Statement, providing Benchmark Administrators with payroll records, including documenting 52 weeks of the injured worker’s salary history. If 52 weeks are not available, provide payroll records for the time period the injured worker was employed.
  3. Complete Form 113 Notice of Designated Physician.  The injured worker may choose the physician (including chiropractors) who treats him/her as the “designated physician.”  This notice identifies the designated physician where the injured worker is receiving medical care.  You will need to provide this form to Benchmark Administrators within 10 days from the start of treatment.
  4. If you are a drug free work place, post-accident drug testing must be completed in accordance with your drug-free workplace policy procedure.
  5. Contact a preferred urgent care facility by telephone prior to sending the injured worker. Inform the urgent care you have an injured worker coming and that Benchmark Administrators is the claims administrator.
  6. Advise the injured worker to return to your office or job site after receiving medical care and provide the doctor’s signed return-to-work slip or documentation of medical disability. Please forward the return-to-work/disability slip from the doctor to Benchmark Administrators as soon as possible.

If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist with any insurance-related information the medical provider may require.

Submit all correspondence and medical bills to:

Benchmark Administrators
P.O. Box 46350
Las Vegas, NV 89114
Telephone: (314) 558-1273
Toll Free: (800) 362-5198
Fax: (314) 230-7003

Customer Service Representatives are on staff 24 hours per day to assist you with reporting a claim. Please have the injured worker’s information available as well as the accident description.