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South Carolina

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

  1. Complete Form 12A First Report of Injury providing the details of the accident and injury.
  2. Complete Form 20 Statement of Earning of Injured Employee providing wage history for the injured employee.
  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. Contact a preferred urgent care facility by telephone prior to sending the injured worker. Inform the urgent care that you have an injured worker coming and that Benchmark Administrators is the claims administrator.
  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.

Medical Provider Options:

Concentra Urgent Care

Doctors Care

US Healthworks

Correspondence and Medical Billing:

Benchmark Administrators
P.O. Box 46350
Las Vegas, NV 89114
Telephone: (321) 594-7222
Toll Free: (800) 362-5198
Fax: (352) 240-1203

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.