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1000.13 TANF MANUAL 7/24 PAGE 54

(1) Submit the name, case number, and Begin and End date for the individual assigned to CWEP. The CWEP Placements Without Medicaid Coverage form must be completed online at: https://fusion.dss.virginia.gov/bp/BP- Home/TANF-and-VIEW/Forms.

(2) If the client is injured on the work site and wishes to file a claim with Workers’ Compensation, the ESW must provide to the client in writing

a list of three physicians from whom the client may choose to seek

medical attention. The list of three physicians must be entered on the Panel Physician Form and given to the client. The form can be located at https://covwc.com/wp-content/uploads/2023/12/panelphysicianform.pdf Print the form.

c. The CWEP work site supervisor must immediately complete an Employer’s Accident Report form when an accident occurs. This Virginia Workers’ Compensation Commission form can be accessed online at https://www.dhrm.virginia.gov/hr- partners/workers-compensation-hr-resources/workerscompforms. Scroll down to Workers’ Compensation. Click on Employer’s Accident Report form. Print the form.

1. The supervisor must investigate the claim, document work place hazards/conditions involved in accident and complete ‘Employer’s Accident Report’ based upon his investigation.

2. List the employer as CWEP and the agency number as 997. 3. The original form must be sent to: Virginia Department of Social Services Division of Benefit Programs Economic Assistance and Employment Unit Attn: CWEP Placements without Medicaid Coverage 5600 Cox Road Glen Allen, VA 23060

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