Utah

When an employee is injured on the job, proceed with the following:

1. Contact a preferred urgent care facility by telephone prior to sending the injured worker.
   • Inform the urgent care you have an injured worker coming and S & C Claims Services is the claims administrator.
2. If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor accompany the injured worker to assist with any insurance related information that the medical provider may require.
   • If possible, the injured worker must return to your office or job site after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.
3. If there is a serious injury, notify S & C Claims Services immediately by telephone at 1-800- 289-4502.
4. It is necessary that the employer fill out the required Form 122 and notify S & C Claims Services immediately. Please forward the return to work/disability slip from the doctor to S & C Claims Services as soon as possible.

Required State Forms

• Form 122

Additional Forms

• Form A S&C Provo
• Form B S&C Provo
• Form C S&C Provo
• Form D S&C Provo
• Form E S&C Provo
• JOB ANALYSIS FD Provo
• JOB ANALYSIS LD Provo
• OSHA 300 LOG INFORMATION Provo
• Form A – S&C South Jordan
• Form B – S&C South Jordan
• Form C – S&C South Jordan
• Form D – S&C South Jordan
• Form E – S&C South Jordan
• JOB ANALYSIS FD – South Jordan
• JOB ANALYSIS LD – South Jordan
• OSHA 300 LOG INFORMATION S&C South Jordan

Medical Provider Network

FirstMed
441 S. Redwood Road
Salt Lake City, UT 84104
801-973-2588

Intermountain WorkMed
1685 W. 2200 S.
Salt Lake City, UT 84119
801-972-8850

St. Mark’s Hospital
1160 E 3900 S #2000
Salt Lake City, UT 84124
801-266-3418

U of U Hospital
50 Medical Drive
Salt Lake City, UT 84132
801-581-2121

Timpanogas Regional Hospital
750 W 800 N
Orem, UT 84057
801-714-6000

Mountain View Hospital
1000 E 100 N
Payson, UT 84651
801-465-7000