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Worker's Compensation

 

Workers Compensation

Primex

https://nhprimex.org/

Bow Brook Place
46 Donovan Street
Concord, NH 03301-2624

(800) 698-2364
(603) 225-2841

Google Map

Forms

  • Notice of Accidental Injury or Occupational Disease (8aWCA) - the Employee fills this out if they are able.  This form is utilized to give the injured worker the opportunity to describe, in his or her own words, how the injury occurred. This form is to be completed by the injured employee and used by the employer to complete the Employer’s First Report of Injury or Occupational Disease (8WC). The Notice of Accidental Injury or Occupational Disease (8aWCA) is the only form that the injured employee should complete.
  • First Report of Injury (FROI) (8WC) - the Supervisor, Manager, Admin Asst or Dept Head completes this form and returns to HR.  As soon as you have been notified of a work-related injury, please immediately fill out this form and submit it to Town HR and provide a copy to the employee. Please use this form to notify HR of every work-related injury or disease suffered by an employee, regardless of severity.
  • Exposed Worker Incident Report Form - only completed if there is exposure to bodily fluids
  • Accident Investigation Report - (AIR) Completed by the Supervisor, Manager or Dept Head, returns to HR.  This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident.
  • File a Claim - Primex Link for Supervisors/Department Heads if HR is unavailable.

NH DOL Laws and Rules

Chapter 281-A: Workers' Compensation

 

Other NHDOL Information

Town of Milford - Temporary Alternate Duty Program

 

JLMC Manual Page 15 - Temporary Alternate Duty Program

The Town of Milford, by its Board of Selectmen, requires employees who are not totally disabled due to injury or illness and who have the capability to perform some type of work -which may not necessarily be their normal or usual duties -to temporarily work in a light or limited-duty capacity with the permission of their doctor.

 

Employees on disability must provide documentation of their medical status and work restriction(s) from their physician -or from a Town of Milford designated physician -to their respective Department Head after each physician's visit or as requested by the Department Head.

 

Employee Handbook, Chapter 4, page 18

After consultation with the Department Head, if an employee who is on short-term  disability or collecting worker’s compensation benefits is capable of returning to work under the statutorily-authorized Temporary Alternate/Light Duty Program, in the same capacity or another position within the Town, and the employee refuses to return to duty, the Department Head shall have the option of terminating that employee.

 

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