Workers Compensation Process
How to Apply For Workers’ Compensation
- In the event of a work-related illness or injury, an employee should immediately notify a supervisor or administrator.
- The supervisor is responsible for the prompt completion of the Supervisors’ Injury or Illness Investigation Report and notify the Office of Risk Management of the injury.
- The employee is responsible for the completion of the Employee Accident Statement Form.
- Witnesses should complete the Witness Accident Statement Form (if applicable).
- The Office of Risk Management will arrange an initial evaluation of the injury or illness at the required treatment location.
- Treatment cannot be administered without an OMEGA Clinical Passport (for Evanston) or a Treatment Authorization Form (for Chicago), which can be brought into the appointment or faxed prior to the appointment.
- All employees receiving either initial or emergency room follow-up treatment will be given a Duty Status Report indicating when they can resume modified or full duties and whether a follow-up visit with the doctor may be requested. Employees are responsible for ensuring the report is delivered to the Office of Risk Management as soon as possible and that his/her supervisor is notified.
Both the employee and the supervisor have a responsibility to assure that complete and accurate information is conveyed to the University’s Office of Risk Management. Northwestern University employees are advised that if these instructions are not followed, Workers' Compensation claims cannot be reviewed. Employees may not be entitled to Workers' Compensation benefits and can be held responsible for any expenses incurred.
Workers Compensation Resources
- Supervisors Injury or Illness Investigation Report
- Employee Accident Statement Form
- Witness Accident Statement Form
- Omega Clinic Passport - Evanston
- Northwestern Treatment Authorization - Chicago
- Incident Investigation Form
- Evanston Campus Lab Poster
- Chicago Campus Lab Poster
- Chicago Workers' Compensation Brochure
- Evanston Workers' Compensation Brochure
- Guidance for Managers and Telecommuting Employees
Guidance for Workers' Compensation Billing
Employee's should inform their respective medical facilities that their visits are in relation to an open workers' compensation claim under Northwestern University and provide the respective claim number. Bills and appropriate records associated with workers' compensation claims should be directed to Juan-Carlos Pérez in the Office of Risk Management via mail, fax, or e-mail.