Immediate Employee Responsibilities

If you are injured at work or believe you have suffered a work-related illness or injury

• Notify your manager immediately.

• Seek emergency medical attention immediately if the injury is serious or life-threatening.

• Complete and submit an Incident Report using the approved reporting link below.

• Cooperate fully with all workers’ compensation reporting requirements.

• Follow all medical treatment instructions and return-to-work requirements.

Required Incident Report Submission

All employees must complete an Incident Report immediately following any workplace injury, accident, or work-related illness. 

Failure to promptly report an injury may delay claim processing and benefits eligibility.

Madison Family Enterprises Incident Report Form

State-Specific Reporting Requirements

All employees must complete the state specific reporting requirement immediately following any workplace injury, accident, or work-related illness. 

Failure to promptly report an injury may delay claim processing and benefits eligibility. Failure to 

Arkansas Employees

• Immediately notify management of the injury.

• Submit the Incident Report through the required reporting link in not already completed.

• Call the Nurse Intake Coordinator at (888) 375-0278.

• Complete and submit a Form N here

Tennessee Employees

• Immediately notify management of the injury.

• Submit the Incident Report through the required reporting link if not already completed.

• Call AMTRUST at (866) 272-9267 option 2

Worker's Compensation Acknowledgements

Drug & Alcohol Testing Notice

Employees are advised that post-accident and/or post-injury drug and alcohol testing may be required as part of the workers’ compensation investigation and claim handling process, subject to applicable state law. Refusal to participate in required testing, tampering with a test, or failure to cooperate may impact eligibility for workers’ compensation benefits and may also result in disciplinary action up to and including termination of employment.

Reporting Requirement

Employees are required to report all workplace injuries, no matter how minor they may initially appear. Failure to promptly report an injury or illness may result in delays, denial of benefits, or disciplinary action.

Accuracy of Information

All information provided during the reporting and claims process must be truthful, complete, and accurate. Providing false, misleading, incomplete, or fraudulent information during a workers’ compensation investigation or claim process may result in denial of benefits, disciplinary action, termination of employment, civil penalties, and/or criminal prosecution.

Cooperation Requirement

Employees are expected to fully cooperate with incident investigations, Insurance carrier requests, medical evaluations, return-to-work programs, safety reviews, and follow-up documentation requests. Failure to cooperate with the workers’ compensation process may affect claim handling and employment status.

Authorized Medical Treatment

Employees may be required to use approved or authorized medical providers in accordance with applicable state workers’ compensation laws and employer insurance requirements. Employees should follow all treatment plans, work restrictions, follow-up appointments, and return-to-work instructions.

Return-to-Work Program

Madison Family Enterprises supports transitional and light-duty return-to-work opportunities when medically appropriate. Employees are expected to provide updated work status documentation after each medical visit and cooperate with temporary work restrictions when available.

Time Away From Work

Any absence related to a workplace injury must be properly documented. Employees must keep management informed regarding

• Work status

• Medical appointments

• Restrictions

• Expected return dates

• Changes in treatment status

Unauthorized absences remain subject to attendance and employment policies.

Privacy & Medical Information

Medical information related to a workers’ compensation claim will be handled in accordance with applicable privacy laws and business requirements.

No Retaliation

Employees will not be retaliated against for reporting a legitimate workplace injury or participating in the workers’ compensation process. However, fraudulent claims, policy violations, unsafe conduct, or dishonesty during the process may still result in disciplinary action.