Provider:
The Hartford
The Diocese of Raleigh provides a comprehensive workers’ compensation insurance program at no cost to employees. This program covers disability incurred through accident or occupational disease—arising out of, and in the course of, employment—that requires medical, surgical, or hospital treatment. In order to be eligible for workers’ compensation benefits, the injured person must be a paid employee of the diocese.
Coverage for the Diocese of Raleigh workers’ compensation insurance is being administered by The Hartford. Eligibility for workers’ compensation benefits is determined solely by their representatives.
To report a work related injury or illness, please follow the procedure below:
- All work-related injuries or illnesses should be reported immediately to the employee’s supervisor within 24 hours.
- The supervisor or location administrator or should complete the Workers’ Compensation First Notice of Loss Form (link above) upon report of the injury or illness. (Note: This form can be filled out using Microsoft Word.)
- Should an employee wish to only report a workers’ compensation injury and not seek any medical treatment, please have them complete the No Treatment Letter (link above) in addition to the First Notice of Loss Form. This form is for HR to have on file should the employee wish to seek treatment at a later time.
- Fax the completed Workers’ Compensation First Notice of Loss Form and No Treatment Letter, if applicable, to the Human Resources Specialist, hr.specialist@raldioc.org, or fax to 1-866-955-8172 within 24 hours after knowledge of the injury or accident.
- Please keep the original copy of the First Notice of Loss Form and No Treatment Letter, if applicable, on file at your location. The original(s) should be kept in a separate folder with other Workers’ Compensation claims and not in the employee’s file.
- All subsequent bills relating to the claim must be sent to the Human Resources Specialist following the same procedure as above.
- Please note: The NC Form 19 is not used to file a workers’ compensation claim with The Hartford. This form will not be accepted, if submitted