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Employee Resources/Personnel

Robert Kalafut, Personnel Officer
(973) 593-3043
50 Kings Road
Madison, NJ 07940 (map)

This page updated 8/31/11

First Report of Injury form

Authorization for Treatment at Work Med form

Worker’s Compensation Procedures:                                             (Posted: 8/31/11)

If you’re injured on the job, you must notify your Supervisor immediately.  Your Supervisor is responsible for reporting the incident to FMCO immediately as well as completing all the necessary paperwork. 

If the injury is severe (life threatening or loss of limb), call 911 or get to an emergency room immediately.

If the injury requires treatment (other than life threatening or loss of limb), report to Work Med at Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ.  Be sure to take with you an Authorization for Treatment at Work Med form which can be obtained from your Supervisor, Stacey Dooley (Administrative Assistant, Purchasing) or Robert Kalafut (CFO/Personnel Officer) or by clicking the link above.  This form will indicate to Work Med that it is a Worker’s Compensation case (which they will determine anyway) AND direct them to send all bills to the Borough of Madison for payment.  If you’ve provided the Authorization for Treatment at Work Med form to Work Med upon your arrival, the bills shouldn’t be sent to you but if they are, forward them (the original bill(s)) to Stacey for processing; do NOT pay them.

If you are injured in any way but do not require treatment, report it to your Supervisor anyway and have him/her call FMCO to put the injury on record.  Your Supervisor must also complete the First Report of Injury (FROI) form, indicating No Medical Treatment was provided.  This will put the injury on record in case anything stemming from this incident occurs in the future.

If, after your case is closed, you have recurring symptoms or any problems you feel may be related to your Worker’s Comp case, contact Stacey who will contact your case manager to see about reopening your case.   Your case manager will advise how to proceed with your case.

**Please note: we cannot prevent you from going to see your own medical provider but please be advised that if you do go to your own medical provider and it is related to your Worker’s Comp injury, the services will NOT be paid for by the Worker’s Compensation carrier.  Additionally, if your medical carrier determines the services were provided in conjunction with a Worker’s Compensation case, it is possible they may not pay either.

Supervisor’s Responsibilities

1.  Under NJ Workers Compensation Law and the Federal U.S. Department of Labor Law the Employer is required to report any employee recordable injury.  The Supervisor must immediately call FMCO (First Managed Care Option) at 1-800-831-9531.  If there is no answer, the Supervisor needs to keep trying until someone is contacted and a report is made.

2.  Fill out a FROI (First Report of Injury)

- On page 1, do NOT fill in the Wage Rate, but be sure to fill in the Number of days worked per week.

- On page 3, on the line that says “Date Administrator (TPA) notified”, please fill in the date that you contacted FMCO.

- Also on page 3, in the Medical Provider section, do not fill that out unless the employee actually had treatment performed.  This does not mean the employee’s own personal doctor or insurance carrier.

3. If the employee refuses medical care or does not get any medical treatment, it is still necessary to call FMCO to put the incident on record and to fill out a FROI.  In case something does happen in the future all the necessary paperwork has been completed timely and it is in the system.  Please note: All Supervisors are obligated under the law to report an incident of which they are aware.

4.  Make sure that the original FROI report and any other associated documents (police reports, medical reports, etc.) are provided to Stacey Dooley, Administrative Assistant, Purchasing.  Providing all that information up front will save everyone time.  Please be sure to forward the completed FROI report to Stacey within 2 days of the incident since she has deadlines that she has to meet.

5.  Please do NOT fax the FROI report to Scibal.  There is additional information that must be completed by Robert Kalafut, CFO/Personnel Officer, and Stacey before the report is forwarded to them.  Stacey will take care of forwarding the fully completed FROI and documentation to the correct adjuster.  Please note: Stacey is the first point of contact for Worker’s Compensation issues.

6.  When Stacey receives worker’s compensation updates for cases, she will e-mail the department heads with the updates.  Sometimes a response will be needed from the department.

If you have any questions regarding these procedures, please contact Robert Kalafut or Stacey Dooley.