WORKERS’ COMPENSATION INSURANCE
<CARRIER>
(800) 555-1234
Policy #
Designated Provider #1
123 Main Street
Anytown, CO 80000
Designated Provider #2
123 Main Street
Anytown, CO 80000
Phone: 303-555-1234
Designated Provider #3
123 Main Street
Anytown, CO 80000
Phone: 303-555-1234
Designated Provider #4
123 Main Street
Anytown, CO 80000
Phone: 303-555-1234
Phone: 303-555-1234
dial 911
If your situation is a medical emergency requiring immediate attention,
or
proceed to the nearest hospital which provides emergency services. Follow up care, and nonemergency medical care is to be performed by one of the above listed providers.
Use of network does not confirm or verify compensability under the Workers' Compensation Act, which is
determined solely by the claims administrator.
This document is provided as a service by:
www.autorisk.org