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  1. Go IMMEDIATELY to the ER.
  2. A House Officer must notify his/her supervisor and/or designated departmental liaison immediately. Within five (5) days, they will fill out the necessary paperwork* to report the incident and to provide Human Resources with the information needed to file a Worker's Worker’s Compensation claim.
  3. Once the required forms are submitted, the House Officer will be given a Worker's Worker’s Compensation claim number and billing address for his/her provider to bill the Worker's Worker’s Compensation carrier directly.
  4. Within fifteen (15) days of the incident, if the House Officer has not received a claim number or further direction, they are to contact Brandon Nicholas Mark Gele in Human Resources to verify that a claim was filed. Claims filed beyond thirty (30) days of the date of injury may be ineligible for Worker's Worker’s Compensation benefits.
  5. For follow up care, the House Officer may go to the provider of his/her choice, or can visit one of the participating Concentra clinics (appointments are required). Please contact Brandon NicholasMark Gele-Human Resources for additional information.

See also the LSU Health Sciences Center Policy on Worker's Worker’s Compensation Policy(http://www.lsuhsc.edu/administration/hrm/relations-workerscomp.aspx) and the LSU Health Sciences Center Incident and Accident Reporting and Investigation Policy(https://www.lsuhsc.edu/admin/pfm/ehs/iaform.aspx).

*If any injury occurs on the job, it is necessary for the House Officer's Officer’s Department to notify Brandon Nicholas Mark Gele in Human Resource Management via phone immediately at 504-568-24557812.  The Department will then complete the DA 1973 (https://www.lsuhsc.edu/admin/pfm/ehs/docs/DA1973.pdf *) and DA 2000 (https://www.lsuhsc.edu/admin/pfm/ehs/docs/DA2000.pdf) forms and send them to IncidentReports@lsuhsc.edu.

To report an injury or to gain further information:Brandon Nicholas

Mark Gele- Human Resource

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Management
433 Bolivar Street, 6th

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Floor
New Orleans, LA 70112
(504) 568-

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7812
hrmfmla@lsuhsc.edu

The addresses and phone numbers for the Concentra Medical Center locations are:

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