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Utah

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

  1. 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.
    • Advise the urgent care you require a mandatory drug test per the insurance company.
  2. 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.
    • If possible, the injured worker must return to your office or job site after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.
  3. If there is a serious injury, notify Benchmark Administrators immediately by telephone at 1-800-289-4502.
  4. It is necessary that the employer fill out the required Form 122 and notify us immediately. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.

Required State Forms

Provo - Form 122

Medical Provider Network

FirstMed
441 S. Redwood Road
Salt Lake City, UT 84104

801-973-2588

Intermountain WorkMed
1685 W. 2200 S.
Salt Lake City, UT 84119

801-972-8850

St. Mark’s Hospital
1160 E 3900 S #2000
Salt Lake City, UT 84124

801-266-3418

U of U Hospital
50 Medical Drive
Salt Lake City, UT 84132

801-581-2121

Timpanogas Regional Hospital
750 W 800 N
Orem, UT 84057

801-714-6000

Mountain View Hospital
1000 E 100 N
Payson, UT 84651

801-465-7000

Please send the Form 122 and the medical slip to:

Benchmark Administrators
3601 N. University Avenue #200
Provo, UT 84604
Toll free (800) 362- 5198
Fax (801) 623-6035

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.