FISD Workers’ Compensation

Benefits Coordinator: Kimberly Kempken
[email protected]
Phone: 281-482- 1267
Fax: 281-996- 2606

Injuries on school premises are covered under Worker’s Compensation. Injuries must be reported to the school nurse or campus contact as soon as they occur and a First Report of Injury must be completed. To file a First Report of Injury (FROI) go to www.tasbrmf.org
Worker’s Compensation is covered by a different insurance company than the district’s health insurance plan.
If an employee is going to be treated for their injury they must go to a clinic in the Alliance.


Forms:

Verification of Employment
Send with employee to clinic

Optum Prescription Card
Send with employee to clinic

Election of Leave Benefits
Election of Leave Benefits (Spanish)
Return to Benefits Coordinator

Employee Acknowledgement of Alliance
Employee Acknowledgement of Alliance (Spanish)
Return to Benefits Coordinator

Employee Notice of Alliance
Give a copy to the injured employee

• Notice of Injured Employee Rights
Notice of Injured Employee Rights (Spanish)
Give a copy to the injured employee