Workers Compensation

Workers Compensation State of Maryland First Report of Injury

Workers Compensation is a policy that pays benefits to an employee (or an employee’s family) if the employee suffers a job-related injury (including death) or disease related to work.  Any time an employer is aware an employee has sustained an injury in the course of their employment, it is critical that a Maryland First Report of Injury form be completed. The State form must be completed by the injured worker’s supervisor or next higher level supervisor. Under no circumstances is the State form to be completed by the injured worker. Once the form is completed, you are to then either e-mail or fax the First Report of Injury to the designated contact provided below. If you should have any questions about reporting a claim, please contact the appropriate associate with SISCO listed below.  You can present the injured worker with this Frequently Asked Questions brochure.

If the worker is refusing treatment, the appropriate refusal of treatment document should be completed and filed in accordance with your record keeping policies.

AOB- Refusal of Treatment- Workers Compensation                                                        ACC – Refusal of Treatment- Workers Compensation

For more information about Workers Compensation benefits, contact Tom Alban

Please select your employment category below to send the First Report of Injury Form to the correct Claims Administrator.  There are 3 choices below:  AoB Employee, Catholic Charities Employees, and Jenkins Memorial Nursing Home, Inc. – St Elizabeth Rehab and Nursing Center Employees ONLY.

Workers Compensation Third Party Administrator Filing Instructions

Please click the tab below for instructions

Archdiocese of Baltimore Employees

Archdiocese of Baltimore Employees

Claims Administrator: RCM&D/SISCO

555 Fairmount Ave.
Towson MD  21286
Email form to: Cindy Porter
Cporter@rcmd.com
410-339-5223 
Employer Name
and Address:
Archdiocese of Baltimore

320 Cathedral Street
Baltimore MD  21201

Catholic Charities Employees

Catholic Charities Employees

Claims Administrator: RCM&D/SISCO

555 Fairmount Ave.
Towson MD  21286
Email form to: Tyrese Thomas
Tthomas@rcmd.com
410-427-6422 
Employer Name
and Address:
Archdiocese of Baltimore

320 Cathedral Street
Baltimore MD  21201

Jenkins Memorial NH, Inc – St Elizabeth Rehab and Nursing Ctr Employees

 

Jenkins Memorial Nursing Home,
Inc -St Elizabeth Rehabilitation and
Nursing Center Employees ONLY

Claims Administrator: Chesapeake Employers Insurance

8722 Loch Raven Boulevard
Towson MD  21286
Email form to: FROI@ceiwc.com
Or call Injury Reporting Hotline:
888-410-1400
  www.ceiwc.com
Employer Name
and Address:
Jenkins Memorial Nursing Home,
Inc
St Elizabeth Rehabilitation
and Nursing Center
3320 Benson Avenue
Baltimore MD  21227