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Louisiana

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

  1. Complete Form WC 1A-1 First Report of Injury providing the details of the accident and injury.
  2. Provide payroll records for 12 weeks prior to the week of the accident.
  3. If you are a drug free work place, post-accident drug testing must be completed in accordance with your drug free work place policy procedure.
  4. Provide Form WC1121 – Physician Choice Form to the injured worker for completion. The injured worker is entitled to choose their own hysician to provide medical care and should provide the physician information on this form. However, should they not have a preferred physician and request your assistance, you are able to assist them in finding a physician and they must acknowledge they are choosing to treat with a recommended physician.
  5. Advise the injured worker they must 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.
  6. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.
  7. 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 the injured worker with any insurance related information that the medical provider may require.
  8. If there is a serious injury, notify Benchmark Administrators immediately by telephone, Injured Workers’ Hotline 1-800- 289-4502.

Correspondence and Medical Billing:

Benchmark Administrators
P.O. Box 940097
Maitland, FL 32794
Telephone: (321) 594-7222
Toll Free: (800) 362-5198
Fax: (352) 240-1203

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891
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.