Workers Compensation Overview

Learn about our comprehensive workers compensation services and how we can help you.

Mission Statement

The mission of the Workers’ Compensation Program is to determine coverage and provide benefits for work related injuries sustained by employees of the Navajo Nation and its insured enterprises. We are devoted to establish efficient claim services through medical providers to assist the injured worker in obtaining the best medical care possible for prompt return to work.

We will provide adequate education to eligible employees and employers throughout the Navajo Nation, in filing a claim and types of benefits offered. Every employees will be given an opportunity to file a claim and the right to appeal a decision made by the program which might affect their claim.

We will strive to develop self confidence among injured employees, treat them with respect, and encourage them in reaching maximum medical improvement. Our continued success is dependent upon ensuring immediate delivery of benefits, fairness in claims practice, and responsible medical management.

Services

We take care of all aspects related to workers compensation, ensuring your employees are protected and supported.

Administers the Navajo Nation self-funded Workers’ Compensation Program.

Accepts applications for coverage and determines coverage eligibility for participation in the Navajo Nation Workers’ Compensation Program.

Provides management and adjudication of claims pursuant to the Navajo Nation Workers’ Compensation Act as codified in 15 N.N.C. §§ 1001, et seq.

Claims Processing Flowchart Responsibilites

Important Forms and Documents

Access and download necessary forms and documents.

Medical Waiver Form

Complete this form to waive medical coverage.

Report of Injury Form

Use this form to report any workplace injuries.

Traditional Healing Form

Submit this form for traditional healing requests.

Travel Expense Report

Use this form to record and itemize your travel expenses related to workers' compensation cases, usually for reimbursement or accounting purposes.

IHS: Authorization for Disclosure of Medical Information:

Submit this form, to give permission for your medical information to be shared with others, typically for workers' compensation cases or related purposes.

Consent Form

Consent to Access and Share Medical and Financial Records: This emphasizes the sharing of information between parties involved in the insurance process.

Employee's Responsibility:

Complete and submit Report of Injury form to NNWCP
Report injury to supervisor and/or colleague
Seek medical attention, if needed
Submit doctor's statement to NNWCP and employer
Update NNWCP on follow up appointments

Supervisor's Responsibility:

Check on injured worker, recommend for medical attention
Make initial inquiries and investigation
Provide supervisor statement to NNWCP
If injured worker is incapacitated, complete and submit Report of Injury form to NNWCP
Submit supporting documentation

Required Documents/Forms include but not limited to the following:

Employment Verification (document should include Effective Date, Employer Name, Title, Hourly Rate)
Accident or Police Report
Photographs of accident area and injury
Witness statement
Job description
Shift, Weekly, or Monthly schedules
Official Timesheets
Doctor/Work statement
Travel Authorization
Meeting Agenda and Sign In Sheets
Vehicle Mileage Log
Medical consent forms
Medical referral notices
Travel Expense Reports

Workers Compensation Program Staff

Our office is no longer located at the Navajo Nation Shopping Center, Suite 13-A in Window Rock, AZ as we have relocated to Navajo Nation Administration Building #1 (Admin 1) on the South end of the second floor. The building maintains an elevator and is located by the front entrance.

As of today, business as usual has resumed for our office. The telephone and fax numbers remain the same and are operational at this time. Our telephone number is 928-871-6839 and fax number is 928-871-6083.

Kimberly Bitsilly

Program Supervisor II

kbitsilly@navajo-nsn.gov
928-871-6082

Kordell Curley

Office Specialist

kordell.curley@navajo-nsn.gov
928-871-6389

VACANT

Records Clerk

VACANT

Mailing Address

Workers' Compensation Program
P.O. Box 2489
Window Rock, AZ 86515-2489

Physical Address

Workers' Compensation Program
Administration Building 1
2nd Floor
2559 Indian Route 100
Window Rock, AZ 86515-2489

Telephone Number

928-871-6389

Email Address

wcp@navajo-nsn.gov

Mission Statement

Services

Important Forms and Documents

Access and download necessary forms and documents.

Medical Waiver Form

Report of Injury Form

Traditional Healing Form

Travel Expense Report

IHS: Authorization for Disclosure of Medical Information:

Consent Form

Employee's Responsibility:

Supervisor's Responsibility:

Required Documents/Forms include but not limited to the following:

Workers Compensation Program Staff

Kimberly Bitsilly

Program Supervisor II

Kordell Curley

Office Specialist

VACANT

Records Clerk

Mailing Address

Physical Address

Telephone Number

Email Address

Employee Benefits

Risk Management

Safety/Loss

Workers Compensation

Location

Links