Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees

CC	-Form	-1A	              	Oklahoma Workers' Compensation Notice and Instruction to Employers and Employees	 	
 
All  employees  of  this  employer  who  are  entitled  to  benefits  of  the  Administrative  Workers'  Compensation  Act  are  hereby  notifi	ed 	that  this  employer  has 	
complied  with  all  rules  of  the  Workers'  Compensation  Commission  and  that  this  employer  has  secured  payment  of  compensation  fo	r  all  employees  and  their 	
dependents in accordance with the Act.  All employees are further notified this employer will furnish first aid, medical, sur	gic	al, hospital, optometric, podiatric, 	
and nursing services, medicine, crutches and other apparatus as may be reasonably necessary in connection with the injury rec	eiv	ed by the employee, as well as 	
payments of compensation to any injured employee or the employee’s dependents as provided in the Act.	 	
 
Any  employee  who  has  suffered  a  compensable  injury  covered  by  the  Administrative  Workers'  Compensation  Act  is  entitled  to  voc	ational  rehabilitation 	
services, including retraining and job placement, if, as a result of the injury, the employee is unable to perform work for w	hic	h the person has previous training 	
or experience.	 	
The  Oklahoma  Workers'  Compensation  Commission 
has  a  Counselor  Division  to  provide  information  to 
injured  workers,  employers,  and  other  interested 
persons. 	 	
 
Mediation is available to help resolve certain workers’ 
compensation  disputes.    For  information,  call  the 
Counselor  Division  at  405	-522	-5308  or  In	-State  Toll 	
Free 855	-291	-3612.	 	
Signature of Employer	 	
Insurer Name and Address	 	
Employee's Responsibilities In Case of Work Related Injury	 	
 
If  accidentally  injured  or  affected  by  cumulative  trauma  or  an  occupational  disease  arising  out  of  and  in  the  course  of  emplo	yme	nt,  however  slight,  the 	
employee  should  notify  the  employer  immediately.    If  this  employer  is  a  partnership,  notice  shall  be  given  to  any  partner.    I	f  this  employer  is  a  corporation, 	
notice shall be given to any agent or officer of the corporation upon whom legal process  may be served.  Notice shall also be	 given to the person in charge of 	
business  at  the  location  of  operations  where  the  injury  occurred.    Unless  oral  or  written  notice  is  given  to  the  employer  wit	hin	 thirty  (30)  days,  the  claim  for 	
compensation may be forever barred.	 	
 
The  employee  may  file  a  claim  for  compensation  with  the 	WORKERS’  COMPENSATION  COMMISSION 	for  an  accidental  injury,  death,  cumulative 	
trauma  or  occupational  disease  or  illness  occurring 	ON  OR  AFTER 	February  1,  2014.      Forms  to  file  a  compensation  claim  should  be  furnished  by  this 	
employer and also are available from the Workers’ Compensation Commission.  The forms are posted on the Commission’s website,	 ww	w.wcc.ok.gov.	 	
 
A claim for compensation must be filed with the Commission within the time specified by law, or be forever barred.  Based on 	law	 effective February 1, 2014, 	
a  claim  for  compensation  for  any  accidental  injury  must  be  filed  with  the  Commission  within  one  (1)  year  of  the  date  of  injur	y; a  death  claim  must  be  filed 	
within  two  (2)  years  of  the  date  of  death;  a  claim  for  compensation  for  occupational  disease  or  illness  must  be  filed  within 	two	 (2)  years  of  the  last  injurious 	
exposure; and a claim for compensation for cumulative trauma  must be filed within one (1) year of the date of injury.  A clai	m  f	or additional compensation is 	
barred unless filed within one (1) year of the last payment of disability compensation or two (2) years from the date of inju	ry, whichever is longer.	 	
 
Claims for compensation for accidental injury, death, cumulative trauma or occupational disease or illness occurring BEFORE F	ebr	uary 1, 2014 may 	
be  filed  with  the  WORKERS’  COMPENSATION  COURT  OF  EXISTING  CLAIMS  and  are  subject  to  different  notice  of  injury  requirements  a	nd 	
claims filing deadlines than those for accidental injury, death, cumulative trauma or occupational disease or illness occurri	ng 	on or after February 1, 	
2014.    Failure  to  comply  with  applicable  notice  requirements  and  deadlines  may  operate  to  forever  bar  the  claim.    Contact  the	 WO	RKERS’ 	
COMPENSATION COURT OF EXISTING CLAIMS for additional information.	 	
 	
Employer's Responsibilities	 	
 
The employer must provide employees with immediate first aid, medical, surgical, hospital, optometric, podiatric, and nursing	 services, medicine, crutches and 	
other  apparatus  as  may  be  reasonably  necessary  in  connection  with  the  injury  received  by  the  employee.    This  applies  to  care 	for	 all  injuries  and  illnesses 	
arising out of and in the course of employment, regardless of their character.  Within ten (10) days  after the date of receip	t of notice or knowledge of death or 	
injury  that  results  in  more  than  three  days’  absence  from  work  for  the  injured  employee,  the  employer  MUST  send  a  report  ther	eof	 to  the  Workers’ 	
Compensation Commission on a CC	-Form 2, and also send a copy of the CC	-Form 2 to the employer’s insurance carrier, if any, withi	n the ten	-day period.	 	
 
No  agreement  by  any  employee  to  pay  any  portion  of  the  premium  paid  by  the  employer  to  a  carrier  or  a  benefit  fund  or  departm	ent	 maintained  by  the 	
employer  for  the  purpose  of  providing  compensation  or  medical  services  and  supplies  as  required  by  the  workers’  compensation 	law	s,  shall  be  valid.    Any 	
employer who makes a deduction for such purposes from the pay of any employee entitled to benefits under the workers’ compens	ation laws shall be guilty of 	
a misdemeanor.	 	
 	 	No agreement by any employee to waive workers' compensation rights and benefits shall be valid.	 	 	Any person who commits workers' compensation fraud, upon conviction, shall be guilty of a felony	 	
punishable by imprisonment, a fine or both.	 	
Workers' Compensation Commission	 	
1915 North Stiles Avenue	 	
Oklahoma City, Oklahoma  73105	-4918	 	
Tele.  405	-522	-5308 (OKC) · 918	-295	-3732 (TU)  · In	-State Toll Free 855	-291	-3612	 	
Web Site · www.wcc.ok.gov	 	
This notice must be posted and maintained by the employer in one or more conspicuous places on the work premises.	 	 Revised 12	-18-14 	
Date  of  Expiration  of  Insurance  Policy  (Not  applicable  to  employers authorized to self	-insure.)