Accidents and injuries
If one of your employees is hurt in an accident and it may be someone else’s fault, your employee should let us know. It’s important for them to complete the accidents and injuries forms. We can’t pay their medical bills until they do.
Your employee must complete all 4 of these forms:
- Accident inquiry formDownload PDF
- Repayment agreementDownload PDF
- Statement of factsDownload PDF
- Authorization for the release of Protected Health InformationDownload PDF
No claims will be paid until all 4 forms are completed, signed, and returned to the Culinary Health Fund. If your employee has a lawyer, they must sign the Repayment Agreement form
Why does my employee need to fill out these forms after an accident?
If the accident is someone else’s fault, your employee shouldn’t get stuck with the bills, and neither should the Fund. The other person may have to pay us back for some or all of the medical bills we cover.
When a doctor notifies us that your employee has been hurt in an accident, they will receive a letter and forms in the mail asking questions about the accident.
- Your employee should fill out and sign the papers.
- If they have a lawyer, the lawyer should also complete the forms.
- All completed papers should be sent back to the Culinary Health Fund.
If there is a lawsuit and a settlement is reached, your employee should make sure the settlement includes the future cost of health care related to the injury. Once a settlement is signed, the Culinary Health Fund may deny future claims.