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Incident-Accident-Injury-Envelope-Docs.doc

Incident-Accident-Injury-Envelope-Docs.doc - BOCES...

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Tompkins-Seneca-Tioga-Board of Cooperative Educational Services (TST BOCES) has revised its Worker Compensation Insurance Program and Claims processing procedures. All Medical Claims, C-4 Forms and/or correspondence, pertaining to an employees’ injury occurring in our facility should be sent directly to: Tompkins-Seneca-Tioga Schools Workers Compensation Plan Attn.: Kim Cummings P.O. Box 772 Canton, NY 13617 Policy # W 871503 1-315-379-3071 1-315-379-3072 (Fax) The completed, Return To Work Form (enclosed) must be submitted to: TST BOCES Attn.: Sherry Murray, Employee Benefits Manager 555 Warren Rd. Ithaca, NY 14850 1-607-257-1551 ext. 1034 1-607-697-8273 (Fax) Please Note: TST BOCES is committed to a safe work environment for our employees, and look forward to receiving your documentation as well as a “restriction free” return to work or “out of work” (with a timeline) note. Should you have any questions, please contact: Sherry Murray, Employee Benefits Manager, 607-257-1551, ext. 1034 or [email protected] .
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