102 East Parmenter Lamar, CO 81052 Phone No.: 719-336-4376 FAX No.: 719-336-1363 For on-the-job injuries, all employees must obtain treatment of work-related injuries and illnesses from the following authorized medical providers: Eads Medical Clinic dba Weisbrod Clinic 1211 Luther St. Eads, CO 81036 (719) 438-2251 Prowers Medical Center Clinic 403 Kendall Drive Lamar, CO 81052 (719) 336-6767 NOTE: In the case of an emergency situation, you should go to any physician or medical facility that is able to provide care. Once the emergency has resolved, the provisions above apply. If you are away from the usual place of employment at the time of the injury, you may be referred to a physician in the vicinity of the injury. If an employee is treated by an unauthorized medical provider, the employee will be responsible for payment of said treatment. The insurer responsible for the claim is CIRSA. The following are designated as the Employer and Insurer representatives: City of Lamar Margaret Saldaña, Human Resources Manager Lamar, CO 81052 (719) 336-1366 CIRSA Workers' Compensation Claims Department 3665 Cherry Creek North Dr. Denver, CO 80209 (303) 757-5475 or (800) 228-7136_ All employees must sign below and return to the Human Resources Office on behalf of the City Administrator’s office acknowledging the policy. This list was provided to by ______________________________ (Deliverer name – please print) on_______________________ , by Date □ Hand delivery ☐U.S. mail □ E-mail □ Other Signature of Injured Worker /Claimant Date Des ignat ed Prov ider Lis t
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