If you just had a jobsite accident to report, make sure you have done the following injury checklist.
- Stay calm
- Inform the facility that there was a jobsite injury (workers comp).
- Inform the facility that a mandatory drug screening is required with treatment.
- Give the medical facility the PEOPayGo contact information
954-893-5544
&
claims@peopaygo.com
email for billing and treatment
instructions.
-
954-893-5544
and speak to a PEOPayGo representative.
- Complete the injury report below right away!
Note: All initial treatment, follow-up treatment, and benefits MUST BE PROCESSED THROUGH THE INSURANCE COMPANY.
Follow up treatments or therapy will not be covered outside of the carrier’s network.
We are dedicated to providing the best treatment and benefits to the injured employee. We will be in contact
with you shortly.
Thank you!
PEOPayGO Claims Team
Witness Information
I, the undersigned witnessed or am reporting the injury by personal observation or reported by the listed
witness, and I do hereby affirm that each and every declaration I’ve made in the above-referenced report of
injury or illness is true and correct to the best of my ability. I further affirm I have made the
declarations of my own free will, without coercion, promises or enticements of any type. I voluntarily
present this information, and with this authorization, hold harmless any recipient of the information who
uses or shares the information in any way. I know that any falsification of information herein may result in
a criminal matter and that any person who knowingly presents a false statement for the fraudulent payment of
a loss is guilty of a crime, and may be subject to fines and confinement in a state prison.
