1. HILDEBRAND MCLEOD & NELSON
REPRESENTING INJURED RAILROAD WORKERS SINCE 1926
FREDERICK L. NELSON QUYNHL. NGUYEN VICTOR A. RUSSO
DAVID B. DRAHEIM RYANJ.OTIS MICHAEL J. VENER
ANTHONY S. PETRU BRADLEY W. WAHRLICH JAMES ROBERTS
KRISTOFFER S. MAYFIELD
350 FRANK H. OGAWA PLAZA 700 NORTH BRAND BLVD.
FOURTH FLOOR SUITE 860
WWW.HMNLAW.COM
OAKLAND, CA 94612 GLENDALE, CA 91203
1-800-447-7500 1-800-447-7500
IF YOU ARE INJURED WHILE ON DUTY:
I. Obtain medical treatment as soon as possible. You have the right to see the medical provider of your choice. You do not have to use railroad provided
treatment centers. If threatened with insubordination, comply with managers request and then seek treatment with your own medical provider or hospital.
2. Do not allow railroad management into the examination room, or to discuss treatment of your injury with your medical provider or your family.
3. Do not fill out the accident report until you are mentally and physically able.
4. Do not give a taped or written statement to the railroad.
5. Immediately contact our Office or your Union Representative to help you fill out the accident report if you are unsure of how to answer any question.
Call Hildebrand McLeod & Nelson, Inc. 1-800-447-7500
Important Medical Information for Medical Providers:
• All medical bills are paid through the employee's group health insurance policy.
• Railroad workers do not have any rights under state worker's compensation.
• When injured on the job, railroad workers are governed by the Federal Employer's Liability Act
("FELA") .
• FELA does not have a medical provision clause.
• The employer railroad does not have a right to talk to the employee's medical providers, obtain medical
records, or participate in medical examinations without the employee's prior approval.
• Employees and medical providers are not required to get the company's authorization for medical
treatment.
• The employer railroad might process the bills, but that does not waive the employee's doctor/patient
privilege.
UNDERSTANDING YOUR RIGHTS UNDER FELA IS THE FIRST STEP IN PROTECTING YOUR RIGHTS.
CONSULT WITH HILDEBRAND, McLEOD & NELSON,INC.
1-800-447 -7 500
www.hmnlaw.com
Designated Legal Counsel- Investigators/Consultants
Ron Reich C (510) 501-9818 reich@hmnlaw.com Thomas Lelevich C (916) 947-3348 lelevich@hmnlaw.com
Marty Dollar C (503) 860-1071 dollar@hmnlaw.com Bob Ricou C (661) 303-0972 ricou@hmnlaw.coll1
K.D. Lee C (661) 303-1710 kd.lcs@bak.rr.com John Kallal C (213) 509-3517 kallal@hll1nlaw.coll1
Ronald Johnson C (775) 721-5530 rxrj@aol.com Amy McCarthy C (626) 484-5374 mccarthy@hmnlaw.coll1
Carlos Mora C (916) 764-6701 mora@hnmlaw.com Art Flores C (213) 712-4945 flores@hll1nlaw.coll1
Lou Bottini C (916) 207-1089 bottini@hmnlaw.com Diego Rojas C (909) 238-1105 rojas@hmnlaw.coll1
5. Medical Insurance Information &
Revocation of Health Information Release to Employer
I. Insurance Coverage Not Through Workers' Compensation
To Whom It May Concern:
I, , am an employee with Union Pacific railroad.
As a railroad employee, I am NOT covered by workers' compensation; rather on-duty injuries for
railroad employees are governed by the Federal Employer's Liability Act ("FELA") under 45 U.S.C. §§
51, et seq.
My medical bills are paid through my employee group health insurance policy; there is no
workers' compensation coverage.
You are not required to get my employer's authorization for my medical treatment.
Date: ------- Signed: _
Print name:
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II. I Do Not Authorize the Release of My Health Information to My Employer
To Whom It May Concern:
I, , do not authorize my health care provider,
_____ -::-- _ -:-:::-
_ ' to release any of my health information to my
employer, Union Pacific. In other words, I affirmatively instruct my above-named health care provider
not to release any of my health information to my employer.
I hereby revoke any past authorizations for the release of my health information to my employer.
I also instruct my health care provider to contact me immediately if any person affiliated with
Union Pacific requests my health information.
These instructions remain in effect indefinitely, unless I authorize a release of records to my
employer in writing and pursuant to HIPPA under 45 CFR Parts 160 and 164.
Date: -------- Signed: _
Print name:
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