Workers Compensation

Lake County has a duty to provide employees with procedures for reporting and obtaining medical treatment for on-the-job injuries and/or illnesses.

Supervisors should provide a print out of this specific information to the employee seeking medical attention for an on-the-job injury and/or illness.

If a Lake County employee has an on-the-job injury or illness, the following steps should be taken:

A. Emergency Medical Treatment:

The employee (or employee witness) will notify the supervisor as soon as possible if the injury/illness requires emergency medical treatment and is considered life-threatening.

In the event of a life-threatening injuries or illnesses, someone should call 911 immediately. Employees with life-threatening injuries or illnesses should be transported to an urgent care facility/hospital by ambulance. If unsure whether a medical condition is a life-threatening emergency, 911 should be called.

If possible, the supervisor will complete a First Report of Injury or Illness form and provide a copy of this form to the employee to present to the Urgent Care Facility (e.g., hospital) providing emergency medical treatment. (Refer to Section C – Lake County Workers’ Compensation Reports/Forms.)
If the employee or supervisor has any questions, they should contact the InterCare (Lake County's managed healthcare company) Case Manager, who is available Monday through Friday, from 8:00 - 4:30 p.m. at (800) 431-2221 ext. 4478, or 24 hours a day, 7 days a week at (800) 929-0107.

Examples of life-threatening injuries or illness include, but are not limited to:

Unconsciousness
Broken bones
Sudden dizziness or difficulty seeing
Severe abdominal pain
Trauma or injury to the head
Partial or total amputation of a limb or extremity
Persistent pain or discomfort in the chest or arms
Not breathing or having trouble breathing
No signs or lack of circulation
Severe bleeding
Seizures that are unusual, prolonged or multiple, last more than 5 minutes, result in injury or occur in someone who is pregnant or diabetic
Drug overdose
Eye injuries
Gunshot, knife or other weapons wound
Accidents such as falls or involving motor vehicles
High fever (greater than 101°F) with a severe headache and a stiff neck

B. Non-Emergency Medical Treatment:

If the injury/illness does not require emergency medical treatment and the injury/illness is not considered life threatening, the employee will notify the supervisor immediately. (If unsure whether a medical condition is a life-threatening emergency, 911 should be called.)

The supervisor and employee should work together to complete the First Report of Injury or Illness form and provide a copy of this information to the employee, which the employee will present to the Healthcare Provider. (Refer to Section C – Lake County Workers’ Compensation Reports/Forms.)

If the employee or supervisor has any questions, they should contact the InterCare (Lake County's managed healthcare company) Case Manager, who is available Monday through Friday, from 8:00 - 4:30 p.m. at (800) 431-2221 ext. 4478, or 24 hours a day, 7 days a week at (800) 929-0107.

The employee should use the authorized Healthcare Provider for non-emergency medical treatment.

Express Care of Lake County
2020 Nightingale Lane
Tavares, FL 32778

Phone: (352) 742-1500
Fax: (352) 742-2530 or 742-9024

Hours of Operation:
9:00 a.m. - 6:00 p.m.
(Mon., Tues., Thurs., & Fri.)
9:00 a.m. - 5:00 p.m. (Wed)
9:00 a.m. - 1:00 p.m. (Sat.)

Click here for map and driving directions

If the injury/illness occurs after the Healthcare Provider’s hours listed above, the employee should obtain medical treatment at the nearest Urgent Care Facility (e.g., hospital).

Examples of illnesses/injuries that may not be life-threatening include, but are not limited to:

Rashes
Upper respiratory infections
Sore throats
Earaches
Headaches
Abrasions
Lacerations
Flu like symptoms
Back pain
Sprains
Minor fracture

C. Workers’ Compensation Reports/Forms:

The Workers’ Compensation Report is easily obtained from the Lake County intranet, through
the “Forms” Quick Link or by going to the Employee Services, Workers’ Compensation page.

First Report of Injury or Illness
1. Supervisor and employee must complete the First Report immediately (or as soon as possible, if an emergency situation) after an injury/illness is reported.
2. Supervisor and employee must sign the original report and make a copy.
3. The employee presents the copy of the report to Urgent Care Facility or Healthcare Provider. This report serves as authorization for treatment.
4. Supervisor must fax the report to EMI, Attn: Barbara Dawson at (772) 220-1637.
5. The original/signed report shall be mailed through interoffice mail or hand delivered to the Offices of Employee Services, Admin. Building, Room 430.
First Report of Injury or Illness (Report Only)
1. Supervisor and employee must complete the First Report of Injury or Illness (Report Only) immediately after an injury/illness is reported.
2. Supervisor and employee must sign the original report.
3. Employee elects not to have medical treatment.
4. Supervisor must fax the report to EMI, Attn: Barbara Dawson at (772) 220-1637.
5. The original/signed report shall be mailed through interoffice mail or hand delivered to the Offices of Employee Services, Admin. Building, Room 430.
Lake County Injury/Illness Reports/Forms
The supervisor is responsible for ensuring that all forms are provided and completed. The supervisor should collect all reports/forms and submit them as one packet to the Department of Employee Services as soon as possible.
1. Supervisor Investigation
2. Employee Statement
3. Witness Statement
  1. Supervisor, employee, and witness must complete the respective report immediately after an injury/illness occurs and/or is reported.
  2. The original/signed report shall be mailed through interoffice mail or hand delivered to the Offices of Employee Services, Admin. Building, Rm. 430.
EMI Grievance Policy and Procedure