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Loudoun County Public Schools Workers Compensation Panel of Physicians Dr. Roxana Diva Nova Occupational Health 21785 Filigree Court, Suite 103 Ashburn, VA 20148 7035546644Dr. Smith Teravolt Nova

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How to fill out workers compensation panel of

01

Obtain the workers compensation panel form from your employer or HR department.

02

Make sure to read and understand all the instructions on the form.

03

Fill out the necessary information such as your name, date of birth, employer information, and any relevant medical history.

04

Choose the designated healthcare providers from the list provided on the form.

05

Sign and date the form before submitting it to your employer or HR department.

Who needs workers compensation panel of?

01

Employees who have been injured on the job and are seeking medical treatment covered by workers compensation.

02

Employers who are required by law to provide workers compensation coverage for their employees.

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What is workers compensation panel of?

Workers compensation panel is a list of approved healthcare providers that an employer provides to their employees for treatment of work-related injuries or illnesses.

Who is required to file workers compensation panel of?

Employers are required to file a workers compensation panel for their employees.

How to fill out workers compensation panel of?

Employers must list the approved healthcare providers and instructions on how to seek treatment in the workers compensation panel.

What is the purpose of workers compensation panel of?

The purpose of workers compensation panel is to ensure that employees have access to timely and appropriate medical treatment for work-related injuries.

What information must be reported on workers compensation panel of?

The workers compensation panel must include the names and contact information of approved healthcare providers, as well as instructions on how to seek treatment.

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