BRAIN WORK
WORKERS’ COMPENSATION CORNER Filing a Workers’ Compensation Claim — The C-4 Form
ONE-PAN VEGGIES AND CHICKEN
Inspired by Tasty.co
Ingredients
• 1 sweet potato, cubed • 1 lb Brussels sprouts, halved
• 2 apples, sliced • 4 chicken thighs • 4 tbsp olive oil
• Salt and pepper, to taste • 3 cloves garlic, minced • 1 tbsp rosemary • 2 tbsp thyme
A claim is initiated by the filing of a Claim for Compensation Form, called a C-4 Form. The injured worker generally receives this form from their medical provider at their initial medical visit after the injury.
Directions
The injured worker completes the top portion of the form and the doctor completes the bottom portion and sends it to the employer and/or to the employer’s insurer. The claim is considered filed when the insurer for the employer receives their copy of the C-4 Form from the treating doctor. It is the doctor’s responsibility to make sure that the C-4 Form is completed after discovering that the injury is work- related. It is also the doctor’s responsibility to make sure a copy is sent to the correct insurer for the employer. Depending on doctor’s experience with workers’ compensation, or lack thereof, an injured worker may want to follow up to confirm that the insurer and employer received a copy of the C-4. If a C-4 Form is never completed by the injured worker, and/or it is never received by the insurer, a claim has not been filed. It is insufficient that an employer knows about a work injury or that the injured worker gives his employer a written accident report. The injured worker must also complete a C-4 Form with a doctor to get a claim started. The C-4 Form asks the injured worker for a date the injury occurred. The injured worker must not be careless when giving the date of the accident because the form must be filed within 90 days of the accident. Because this form initiates the claim, it is a very important document and should be completed with care.
1. Preheat oven to 400 F.
2. On a baking sheet, add potatoes, Brussels sprouts, and apples. Layer chicken thighs on top. 3. Drizzle with olive oil. Then season with salt, pepper, garlic, rosemary, and thyme. 4. Turn chicken over and add seasoning to the back side. Return skin-side up before baking. 5. Bake for 30 minutes, and broil for 5–10 minutes afterward.
3 725-867-8495 | WWW.CLAGGETTLAW.COM | WORKERS’ COMPENSATION AND PERSONAL INJURY
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