Risk Management
Workers' Compensation Claim Report

Workers’ Compensation is a no-fault insurance system that pays medical expenses and helps offset lost wages for employees who experience work-related injuries or illnesses. Volunteers and students participating in a clinical may also receive medical benefits for injuries or illnesses that occur during volunteer or clinical assignments. Lost wage benefits are not available to volunteers or students.

Prior to completing this form, please seek medical attention from Intermountain Healthcare WorkMed:
1685 W. 2200 S.
SLC, UT 84119
M-F 7:30 AM – 5:30 PM
201 East 5900 South #100
Murray, UT 84107
M-F 8 AM – 5 PM
1091 W. So. Jordan Parkway, Suite 500
South Jordan, UT 84095
M-F 8 AM – 5 PM

During evening/night/weekend hours wait until Intermountain WorkMed is open, if possible; otherwise, go to a listed Workers’ Compensation Preferred Provider (www.wcfgroup.com). Go to the Emergency Room only for threat of life or limb.

Please log in using your MySLCC Username and Password