POLICYHOLDER CONTACT GUIDE
|
|
- Sara Foster
- 7 years ago
- Views:
Transcription
1 POLICYHOLDER CONTACT GUIDE REPORT AN INJURY PHONE (866) FAX (321) Please copy on the First Report your ECM Solutions Claim Advocate Tammy Burgess Renee Lanier Wanda Jackson SUBMIT MEDICAL BILLS & RELATED MEDICAL NOTES TO: MCMC P.O. BOX 1160 CANONSBURG, PA FAX (724) To expedite the processing, please include the claim #, employee s SS#, date of injury and employer name. ADJUSTER & ADDITIONAL CLAIM DOCUMENTS: SOUTHEAST REGION P.O Charlotte, NC Phone: (888) NURSE CASE MANAGEMENT & PROVIDER RELATIONS (866) SUBROGATION (954) SIU & FRAUD HOTLINE (877)
2 Patriot appreciates the confidence you have placed in our workers' compensation program. Through our network of affiliate and contract providers, we are committed to providing you with efficient service that delivers quality medical care, controls costs, and facilitates returning employees to work in a prompt, safe manner. We emphasize: Prompt Reporting of injuries. Accidents should be reported within 24 hours. Claims Administration that provides adjusting and administrative services that meet state workers' compensation rules and regulations. Case Management that coordinates and monitors injured workers' medical care throughout the recovery process to promote an appropriate return to work. Bill Review that ensures compliance with state fee schedules prevents duplicate submissions and compares charges to treatment received. Provider Panel usage. In some cases Provider Panels may come under separate cover from our Claims Client Services Department. When an Injury Occurs... We urge you to report the injury as soon as it happens. Intake specialists are available 24 hours a day, seven days a week to take your injury report and if necessary, direct your injured worker to the nearest PPO provider. Acknowledgment of your phone call will be faxed to you. A copy of the completed state First Report of Injury form will be faxed, mailed, or ed to you upon request. Refer to the Policyholder Contact Guide for specific phone, fax and options. FOR SERIOUS ACCIDENTS, PLEASE ALSO CALL ONE OF OUR REGIONAL OFFICES IMMEDIATELY Included in your Welcome Packet... First Report of Injury - Use this form should you prefer to fax or your report of injury instead of using the toll free injury hotline. Provider Information - Network medical provider information is listed according to your location and your specific state requirements. Authorization for Release of Medical Information - Please have your injured employee sign this form and fax it to the assigned adjuster or case manager. State-Specific Forms - If applicable, other forms required by your state's workers' compensation regulatory agency are included. If a posting notice is required in your state, it is included and must be posted in one or more conspicuous sites at your place of business.
3 CLAIM MANAGEMENT Frequently Asked Questions After an injury occurs, where should I send my injured employee for medical care? Your Welcome Packet includes a list of preferred providers for your area, and the hotline intake specialist may also direct you to the nearest network provider. Statutory regulations can limit the initial choice of treating medical providers. Call your Claims Adjuster for assistance in determining your jurisdiction's provider choice requirements. Will I receive an acknowledgment after reporting an injury? You will receive confirmation by mail that we have assigned a claim number and adjuster to your employee's injury. What roles do the Claims Adjuster and Nurse Case Manager play in administering the claim? The Claims Adjuster is a licensed professional who will investigate and determine compensability, administer benefits per statutory requirements, and oversee adjudication of claims when necessary. The Nurse Case Manager is a licensed healthcare professional that will work with the injured employee to coordinate medical care and communicate with the employer and the medical provider to facilitate a prompt, safe return to work. Nurse Case Managers and Claims Adjusters work together to provide claim resolution for injured employees. What should I do if a medical provider or pharmacy calls me? Refer them to the Claims Adjuster or Nurse Case Manager assigned to the case. Please refer to the Policyholder Contact Guide for your regional contact. Whom should I call regarding an injured employee's workers' compensation benefits? Contact your regional Claims Adjuster assigned to the case. What should I do if I receive a medical bill for treatment of an injured worker? Mail the bill with any related medical notes to us in care of our bill review partner, MCMC, at P.O. Box 1160, Canonsburg, PA or fax it to MCMC at (724) To expedite processing, please include the claim number, employee's Social Security Number, date of injury and employer name. Where should I send other documentation received, such as, work status notes, state correspondence pertaining to the claim, or injured workers' paid prescription receipts, etc.? Please mail additional claim documentation to your regional Claims Adjuster listed on the Policyholder Contact Guide. What if I have questions about my medical provider listing? Please contact our Provider Relations department listed on your contact guide.
4 Consent for Release of Medical Information I hereby authorize representatives of Patriot Risk Services to obtain and review copies of all medical records related to my workers' compensation injury. This pertinent information will be discussed with other professionals involved in my medical treatment and any institution that, through the "Workers' Compensation Program" or otherwise, is paying all or part of the cost associated with my medical care. Name of Employee Social Security Number Claim Number Telephone Number of Employee address Name of Employer Date of Injury Signature of Employee Date A PHOTOCOPY OR FACSIMILE COPY OF THIS AUTHORIZATION IS AS VALID AS THE ORIGINAL.
5 CLAIM INVESTIGATIONS SPECIAL INVESTIGATIONS UNIT (SIU) The SIU department provides timely and quality claims investigations for the purpose of providing detailed information to the claims staff regarding a reported workers' compensation claim. Providing timely detailed information will properly inform our claims staff so they can assist the injured worker in receiving quality medical care, as well as mitigate the costs of the claim. In order to provide this superior service to our claims staff, we ask our clients to report the workers' compensation injury immediately to our 24-hour toll free number, listed in your Policyholder Contact Guide. SIU CLAIMS INVESTIGATION PROCESS SIU may to go the area where the accident occurred in order to investigate the claim properly. SIU professionals and field investigators have been properly trained to conduct thorough on-site investigations. Below is a list of items that maybe required as a result of the accident. 1. A contact number of those for the accident scene 2. Location of where the accident occurred 3. A list of all witnesses and contact information 4. Please secure the accident area if possible, and save any evidence that might be important to the accident 5. Obtain names of any outside party, (i.e. OSHA, police, fire, paramedics, etc...), who may have responded to the accident area SIU will send a field investigator to the accident scene and properly investigate the scene after discussing with the claims department. Our SIU field investigator will contact the client to arrange a time to meet at the accident scene. In order to properly inform our client in advance, we have listed below the following items that the field investigator may request in order to conduct a thorough investigation. Photographs of accident scene Taking measurements, and other forensic investigative processes, (for example, taking samples, obtaining copy of machinery operating manual, etc...) Recorded statements of all witnesses, and the injured party Obtain copies of all safety reports, witness statements, or other investigative material created as a result of the accident Obtain copies of all maintenance records, if equipment was used Obtain copies of the injured worker's personnel file, and wage information Obtain copies of all training records Obtain copies of all safety procedures that were in place that pertain to this accident type Obtain potential subrogation information, (i.e. building lease information, etc.) Possession of equipment after consulting with the relevant adjuster
6 ANTI-FRAUD PROGRAM CORPORATE STATEMENT ON FRAUD It is our corporate policy, to detect and investigate internal and external suspected fraudulent insurance acts, increase the awareness of the impact of fraudulent insurance acts, and educate personnel in the methods of detecting and preventing insurance fraud. ANTI-FRAUD PROGRAM The components of our Anti-Fraud program include: Detection and investigation of insurance fraud Education and Training of both our claims staff and our clients on identifying fraud and cost containment strategies Referral of suspected fraudulent claims to the appropriate state agencies Compliance with statutory requirements for reporting anti-fraud activities DETECTION AND INVESTIGATION OF INSURANCE FRAUD "RED FLAG INDICATORS" The accident was not reported in a timely fashion by the injured worker The accident occurs just prior to a strike, job termination, layoff, or at the end of a project or the close of seasonal work There are no witnesses to the accident The accident occurs in an area where the employee does not normally work The accident is not the type that an employee should be involved in There are frequent difficulties in contacting the injured worker during his period of disability A "tip" is received concerning the activities of the injured worker while out on disability The injured worker refuses a diagnostic procedure that would confirm an injury or period of disability The injured worker's attorney and/or the treating physician are known to be involved with fraudulent claims The injured worker frequently changes physicians Disability is not substantiated by objective medical findings The injured worker has received a release to return to work, but then changes physicians or medical providers Fraud Posters are available upon request, and can be provided in multiple languages. To report insurance fraud, please contact our Fraud Hot-Line: (877)
7 SUBROGATION Subrogation is described as an insurance carrier's right to recover from a wrongdoer all sums paid to, or for, its policyholder". Virtually every state's workers' compensation subrogation scheme presupposes that a "third party" is liable for causing the injury or death. Exactly who and what qualifies as a "third party" varies by state as well as the statutes governing each individual state. The purpose of the statutes is to protect the carrier, reduce the burden on employers and to ensure that the party, whose negligence caused the loss, bears the ultimate burden for the loss. At Contego Recovery, LLC, subrogation is identified on the front end of the claim. Upon receipt of the First Report of Injury (FROI) the subrogation department reviews all for subrogation potential. Additionally, all department heads are reviewing FROIs. Contego Services Group, LLC can also provide a wide variety of loss control and specialized safety training programs for your company. Our proactive approaches can help your company improve your loss ratios while providing the latest information to enhance your existing work place safety programs. Once it has been determined that there is potential for recovery on the claim, the case is assigned to the Special Investigation Unit (SIU) to investigate and capture information to go forward with a successful subrogation case. During the course a field investigation, we ask our external customers to always save any evidence that might be crucial to the claimant's accident. If the client fails to save crucial evidence, then "spoilage of evidence" could have unfavorable ramifications against the external customer if the claim is litigated. It is very important that our clients properly preserve evidence, and notify the carrier that they are in possession of this evidence. The subrogation specialist will immediately place any and all involved parties on notice of the intent to subrogate and advise them of their duty to protect our lien. The subrogation specialist will place a 30, 60 and 90-day diary and thereafter another 90-day diary until the subrogation/lien has been resolved. The adjuster will keep the subrogation specialist advised of litigation, mediations, and when the claim is close to settlement or closure. Prior to settlement, on a case by case basis, the adjuster and the subrogation specialist will determine the approach to take with regard to what would be most beneficial for the insurance carrier and the policyholder. The majority of the workers' compensation claims will not be settled without or until the third party case has been resolved. Should you have any questions at any time regarding subrogation, please feel free to contact our subrogation department listed on your Policyholder Contact Guide or us at: Subrogation@contegogroup.com.
WORKERS COMPENSATION CLAIMS ADMINISTRATIVE OVERVIEW
WORKERS COMPENSATION CLAIMS ADMINISTRATIVE OVERVIEW Welcome to Chubb Chubb s commitment to providing world-class service has earned us a reputation for claim service excellence that is evident in the speed,
More informationWORKERS COMPENSATION. Claims Handbook
WORKERS COMPENSATION Claims Handbook Contents IMMEDIATE MEDICAL NEEDS of the injured worker...2 LET SOCIETY KNOW when an injury occurs...3 COST CONTAINMENT programs...3 5 WITNESSES and SUBROGATION...5
More informationWorkers Compensation Claim Kit PRAIRIE STATE INSURANCE COOPERATIVE
Workers Compensation Claim Kit PRAIRIE STATE INSURANCE COOPERATIVE A CMI, A York Risk Services Company, publication November 1, 2013 Table of Contents About CMI.... 1 To Report a Claim... 1 The Importance
More informationNorth Carolina Industrial Commission
North Carolina Industrial Commission North Carolina Industrial Commission COMMISSIONERS: Andrew T. Heath, Chairman Charlton L. Allen Bernadine S. Ballance Linda Cheatham Danny Lee McDonald Tammy R. Nance
More informationZurich s Workers Compensation Claims Kit
Zurich s Workers Compensation Claims Kit A guide from a leader you can count on. With 50 state-specific workers compensation laws, a multitude of federal workers compensation laws and the provisions of
More informationBest Practices for Medicare Secondary Payer Compliance Industry Perspectives
Best Practices for Medicare Secondary Payer Compliance Industry Perspectives Presenters: Tara Acton, CenturyLink Cliff Connor, Gallagher Bassett Services, Inc. Roy Franco, Franco Signor, LLC Brad Spicer,
More informationClaims Management. Our Claims Management Mission. Claims Management Team
Claims Management Our Claims Management Mission To provide the highest level of customer service, proactive claims management, and loss control strategies that will reduce the cost of risk, increase customer
More informationManaging the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs)
Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs) This Guide was developed to provide you with valuable information regarding our managed care program,
More informationWORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS
Proposal No. 961-4891 Page 1 WORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS WORKERS' COMPENSATION CLAIMS ADMINISTRATION GUIDELINES The following Guidelines have been adopted by the CSAC Excess Insurance
More informationChecklists for Handling Workers Compensation Claims
Checklists for Handling Workers Compensation Claims Checklist for handling claims The initial period is critical in handling workers compensation claims. Be sure to: Immediately administer first aid accompany
More information19. Injury, Accident, and Loss Reporting
19. Injury, Accident, and Loss Reporting Overview This section discusses the following topics: Where to Report Claims Reporting Workers Compensation Illnesses and Injuries Reporting Automobile Accidents
More informationThe Hartford s California Workers Compensation Medical Provider Network (MPN) Accessing Anthem Blue Cross Prudent Buyer PPO
Employer Implementation Guide Topics Covered in the Guide: Workers Compensation MPN Networks in CA How It Works The Employer s Role Implementation Steps Dealing with Workplace Injuries Employee Rights
More informationFraud. Baldomero Gonzalez. Our reputation for excellence is no accident. TM
Fraud Baldomero Gonzalez Workers Compensation Fraud It is estimated that ten percent of all claims, nearly $31 billion dollars, is paid annually in fraudulent workers compensation claims. Workers compensation
More informationGUIDELINES ON CLAIMS MANAGEMENT FOR THE INSURANCE INDUSTRY
GUIDELINES ON CLAIMS MANAGEMENT FOR THE INSURANCE INDUSTRY JUNE 2012 TO: ALL REINSURANCE COMPANIES ALL INSURANCE COMPANIES ALL INSURANCE INTERMEDIARIES RE: GUIDELINES ON CLAIMS MANAGEMENT FOR THE INSURANCE
More informationEmployee Guidelines for Workers Compensation Accidents
Employee Guidelines for Workers Compensation Accidents The information included in this packet will become important to you in the event that you seek medical attention or lose time from work due to a
More informationWorkers Compensation Claim Fraud
Workers Compensation Claim Fraud Small businesses don t have to be insurance experts to realize the many potential benefits associated with taking a strategic approach to workers compensation and risk
More informationOASIS GROUP. Workers Compensation Claims Call Center. Workers Compensation Injury Reporting Guide
OASIS GROUP Workers Compensation Claims Call Center Workers Compensation Injury Reporting Guide Workers Compensation Injury Reporting Oasis Risk Department 2601 Cattlemen Road Suite 300 Sarasota, FL 34232
More informationBenefits Guide. Information for the Injured Worker
Benefits Guide Information for the Injured Worker The purpose of this benefits guide is to help you learn what to expect if you ever need workers compensation benefits. Recovering from a work injury can
More informationWorker s Compensation Claims Reporting Procedures
Worker s Compensation Claims Reporting Procedures Employer s Claim Management, Inc. P. O. Box 5614 Montgomery, AL 36103-5614 Worker s Compensation Claim Reporting Procedures Your company s Worker s Compensation
More informationWorkers Compensation Subrogation
Workers Compensation Subrogation Golkow Hessel, LLC 1800 JFK Boulevard, Suite 10100 Philadelphia, PA 19103 (800) 277-9010 (215) 988-9400 (215) 988-0042 facsimile www.golkowhessel.com James D. Golkow, Esquire
More informationRISK CONTROL. Workers compensation best practices risk management guide. Risk Management Guide
Risk Management Guide RISK CONTROL REDUCE RISK. PREVENT LOSS. SAVE LIVES. Workers compensation costs are escalating rapidly. In fact, statistics reveal that the direct cost of work place injuries in 1999
More informationRights & Obligations under the Nebraska Workers Compensation Law
Nebraska Workers Compensation Court Information Sheet: Rights & Obligations under the Nebraska Workers Compensation Law NEBRASKA WORKERS COMPENSATION COURT OFFICIAL SEAL What is workers compensation? Workers
More informationThe Seubert Safe Workplace
The Seubert Safe Workplace The Seubert Safe Workplace is a program initiated to help our commercial insurance clients their control worker compensation costs and improve employee health and well-being.
More informationPrimary Casualty Claims Advantages
Primary Casualty Claims Advantages Results Focused Professionals A highly experienced claims team with decades of experience drives better outcomes. Built on years of experience, AIG has developed an unparalleled
More informationGROUP LIFE INSURANCE CLAIM PACKET (Death)
GROUP LIFE INSURANCE CLAIM PACKET (Death) You Can Help Ensure A Quick Claim Decision All required claim forms must be signed, dated and completed fully and accurately. Provide all supporting documentation
More informationEmployer s Handbook. Workers Compensation
Employer s Handbook Workers Compensation Workers Compensation 101 Table of Contents Contact Information. 3 What is Workers Compensation?... 4-5 What is your role?... 6-7 Workers Compensation Benefits 8-9
More informationWorkers Compensation Claims Reporting. What do I do after a Workers Compensation accident occurs?
Workers Compensation Claims Reporting What do I do after a Workers Compensation accident occurs? Secure medical treatment for your injured employee. If during normal business hours, use an Occupational
More informationclaims reporting guide and office directory Delivering unparalleled results
claims reporting guide and office directory Delivering unparalleled results Zurich North America Table of Contents Zurich North America Claims Model Technological Features of the Claims Model How to Report
More informationDISABILITY CLAIM APPLICATION FORMS For Standard / Partial Payment and Dismemberment Plans
DISABILITY CLAIM APPLICATION FORMS For Standard / Partial Payment and Dismemberment Plans INSTRUCTIONS ALL OF THE FOLLOWING PROPERLY COMPLETED FORMS ARE ESSENTIAL TO THE PROMPT PROCESSING OF YOUR DISABILITY
More informationFlorida Managed Care Arrangement. Employer s Handbook
Florida Managed Care Arrangement Employer s Handbook Contents Introduction... 1 Employer Guidelines... 2 Identification Form... 5 Employee Information... 6 Coventry s & HDi s Responsibilities... 8 Frequently
More informationCore Competencies. Investigation
Core Competencies Investigation Claim Investigation Verify coverage for claimant / employer Three point contact (employer, claimant and medical provider) Recorded / written statements (claimant, witnesses,
More informationPersonal Injury Form TODAY'S DATE: PATIENT INFORMATION Last Name: First Name: MI: Birth Date:
ATTORNEY CONCTACT INFORMATION Attorney Name: Office Address: City: State: Zip: Office Phone: Cell Phone: Fax: Attorney Email Address: CASE TYPE Automobile Accident Slip-and-Fall Assault Worker's Compensation
More informationWORKERS COMPENSATION COST CONTAINMENT INITIATIVE
WORKERS COMPENSATION COST CONTAINMENT INITIATIVE 1 Managing Workers Compensation Timely Triage and Reporting Key Items for Reporting Claims Medical Management Return-to-Work Program Managing the TPA Managing
More informationFor Business Owners. Workers Compensation Cost Containment Guide
Harleysville Insurance, headquartered in Harleysville, Pennsylvania, provides a wide array of insurance-related products and services for individuals and businesses through a network of regional insurers
More informationDepartment of Human Resource Management Workers Compensation Services WORKERS COMPENSATION AGENCY MANUAL
Department of Human Resource Management Workers Compensation Services WORKERS COMPENSATION AGENCY MANUAL TABLE OF CONTENTS CHAPTER ONE - CLAIMS PROCEDURES... 3 CHAPTER TWO - WHAT TO DO WHEN AN INJURY OCCURS...
More informationfor Compensation of Certain Death and Physical Injury Claims Pertaining to the GM Ignition Switch Recall
GM Ignition Compensation Claims Resolution Facility FINAL PROTOCOL for Compensation of Certain Death and Physical Injury Claims Pertaining to the GM Ignition Switch Recall June 30, 2014 I. PURPOSE General
More informationMEDICAL LIEN PACKET. With You from Injury to Recovery
MEDICAL LIEN PACKET With You from Injury to Recovery Table of Contents RCW 60.44.010-60.44.060...1 How to Complete a Lien...2 Costs and Procedures...3 Where to File a Lien...4 Notice of Claim Form...5
More informationFILING WORKERS COMPENSATION CLAIMS IN IDAHO
Claims contact information First Report of Injury forms ReportClaim@IdahoSIF.org General e-mail ClaimsIM@IdahoSIF.org FILING WORKERS COMPENSATION CLAIMS IN IDAHO Provider inquiries 208-332-2169 or 800-334-2370
More informationChecklist for personal accident, overseas student or foreign maid claim
Checklist for personal accident, overseas student or foreign maid claim Dear person claiming We are sorry to learn of your illness, injury or stay in hospital. Please send us all the documents listed below.
More informationNC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS
NC WORKERS COMPENSATION: BASIC INFORMATION FOR MEDICAL PROVIDERS CURRENT AS OF APRIL 1, 2010 I. INFORMATION SOURCES Where is information available for medical providers treating patients with injuries/conditions
More informationJob Description ORM-C600... 4. Claims Adjuster 1-4... 4 INTRODUCTION ORM-C601... 7 SET UP NEW CLAIM FILE ORM-C602... 8
Table of Contents Job Description ORM-C600... 4 Claims Adjuster 1-4... 4 INTRODUCTION ORM-C601... 7 SET UP NEW CLAIM FILE ORM-C602... 8 Litigated Claims... 8 Medical Record Review... 9 Investigation...
More informationRepresenting Yourself In Employment Arbitration: An Employee s Guide
Representing Yourself In Employment Arbitration: An Employee s Guide What is the American Arbitration Association? The American Arbitration Association (AAA ) is a not-for-profit, private, public service
More informationU.S. Department of Labor Employment Standards Administration Wage and Hour Division Washington, D.C. 20210. Dear Name*,
August 26, 2005 FLSA2005-25 Dear Name*, This is in response to your request for an opinion concerning whether insurance claims adjusters employed by your client qualify for the administrative exemption
More informationDid the motor vehicle accident in which you were injured or personal injury occur in Maricopa County? Yes No
Welcome to Spooner Physical Therapy! We understand that you have been injured in a motor vehicle accident or other 3 rd party responsible personal injury situation. It is our goal at Spooner Physical Therapy
More informationMONTGOMERY COUNTY SELF-INSURANCE PROGRAM WORKERS' COMPENSATION
MONTGOMERY COUNTY SELF-INSURANCE PROGRAM WORKERS' COMPENSATION INSTRUCTIONS FOR REPORTING WORK-RELATED INJURIES/ ILLNESSES SUPERVISOR'S The following steps should be followed by the supervisor when an
More informationTort and Casualty. Tort and Casualty. Recovery Case Managers Sandy Drews Ron Vialpando. Investigator Deborah Sorensen
Tort and Casualty Recovery Case Managers Sandy Drews Ron Vialpando Investigator Deborah Sorensen Topics for discussion Purpose of Tort and Casualty Referrals Investigator duties Case Manager duties Settlement
More informationZurich Handbook. Managed Care Arrangement program summary
Zurich Handbook Managed Care Arrangement program summary A Managed Care Arrangement (MCA) is being used to ensure that employees receive timely and proper medical treatment with respect to work-related
More informationAN EMPLOYER S GUIDE TO WORKERS COMPENSATION IN NEW JERSEY
AN EMPLOYER S GUIDE TO WORKERS COMPENSATION IN NEW JERSEY I. WHAT IS WORKERS COMPENSATION?... 2 II. WORKERS COMPENSATION BENEFITS... 3 III. INSURANCE REQUIREMENTS... 4 Types of Coverage Definition of Employee
More informationWORKERS COMPENSATION OVERVIEW
WORKERS COMPENSATION OVERVIEW Personnel Coordinator & Workers Compensation Specialist Stark County Commissioners Human Resources Department Canton, Ohio Pg. 18 Claim reporting Red Flags Table of Contents:
More informationONYX BUSINESS AUTO POLICY COVERAGE
ONYX BUSINESS AUTO POLICY COVERAGE Various provisions in this policy restrict overage Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy
More informationPlease have the employee complete this Workers Compensation Signature Packet upon submission of an injury report using:
Please have the employee complete this Workers Compensation Signature Packet upon submission of an injury report using: Online system link located at http://ohr.psu.edu/workers-compensation/ or Call Center
More informationManaged Care Program
Summit Workers Compensation Managed Care Program FLORIDA How to obtain medical care for a work-related injury or illness. Welcome The Summit workers compensation managed-care arrangement (Summit MCA)
More informationWhat to Do When an Accident Occurs - Work Comp Procedures
What to Do When an Accident Occurs - Work Comp Procedures Immediate Response Non-emergency Respond with onsite first aid/cpr responders. Employee must select a physician from the Panel of Physicians form
More informationThe only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing
The only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing Table of Contents: A Comprehensive System for Managing Workers Compensation Claims.... 1 Not All Workers
More informationWILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN
WILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN I. Provisions for the prevention, detection and investigation of workers compensation fraud. Williamson County Government will take all
More informationTEMPLE LITIGATION ADVANTAGE INSURANCE FOR DISBURSEMENTS AND OPPONENT S COSTS Certificate of Insurance
TEMPLE LITIGATION ADVANTAGE INSURANCE FOR DISBURSEMENTS AND OPPONENT S COSTS Certificate of Insurance In return for the payment of the Premium specified in the Schedule and based on any Information that
More informationwww.attorneygeneral.gov
Required fields are marked with an asterisk* Your information: Are you a veteran? Yes No Are you on active duty? Yes No Age Group: Under 18 18-34 35-59 60-64 65 and older Mr. Mrs. Address* Ms. Dr. Name*
More information135 West Bay Street, Suite 400 Jacksonville, FL 32202 Phone: (904)598 1110 or (877)596 5705 Fax: (904)598 1081 erin@deltasettlements.
MSA ALLOCATION PROCESS Please submit the following items for the determination of your Medicare Set-Aside Allocation: 1. Completed Intake Form (attached) 2. Signed Consent to Release for CMS (attached)
More informationChapter 10 Section 5
Claims Adjustments And Recoupments Chapter 10 Section 5 1.0 GOVERNMENT S RIGHT TO RECOVER MEDICAL COSTS The following statutes provide the basic authority for the recovery of medical costs incurred as
More informationBUDGET & FISCAL AFFAIRS COMMITTEE
BUDGET & FISCAL AFFAIRS COMMITTEE WORKERS COMPENSATION PROGRAM COMPLIANCE REQUIREMENTS DIRECTOR, OMAR C. REID April 30, 2013 Workers Compensation Fraud Overview Our Philosophy Common Types of Fraud Employee
More informationDEPARTMENT OF THE NAVY OFFICE OF THE JUDGE ADVOCATE GENERAL TORT CLAIMS UNIT NORFOLK 9620 MARYLAND AVENUE, SUITE 205 NORFOLK, VIRGINIA 23511-2949
DEPARTMENT OF THE NAVY OFFICE OF THE JUDGE ADVOCATE GENERAL TORT CLAIMS UNIT NORFOLK 9620 MARYLAND AVENUE, SUITE 205 NORFOLK, VIRGINIA 23511-2949 FEDERAL TORT CLAIMS ACT CLAIMS PROCEDURES Claims for property
More informationDear Sir/Madam: Thank you for this opportunity to be of service, and please do not hesitate to contact our claims center if you have any questions.
Dear Sir/Madam: Kindly be advised that National Adjustment Bureau has been authorized by underwriters to adjudicate your claim. We look forward to resolving your claim in a prompt and equitable manner.
More informationProtecting the Health Care Subrogation Interest in a Personal Injury Action
Protecting the Health Care Subrogation Interest in a Personal Injury Action (Appeared in National Association of Subrogation Professionals, Subrogator, Winter 2009) By J. Scott Byerley The writer is with
More informationWorkers' Compensation CLAIMS KIT
Workers' Compensation CLAIMS KIT CLMCVR ATTENTION WORKERS' COMPENSATION POLICYHOLDERS! Thank you for placing your Workers' Compensation insurance through CIA Managing General Agency. The carrier for your
More informationNYSIF is leading the fight against workers compensation fraud.
NEW YORK STATE INSURANCE FUND NYSIF is leading the fight against workers compensation fraud. You can help. Red Flags of Claims Fraud Policy and Provider Fraud Reporting Fraud to NYSIF nysif.com N E W Y
More informationAlliance Insurance Company of Zimbabwe (Private) Limited
Alliance Insurance Company of Zimbabwe (Private) Limited MEDICAL PROFESSIONAL INDEMNITY POLICY WHEREAS the Insured, as defined herein, has made to Insurers a written proposal or risk profile bearing the
More informationInjury Reporting Procedure
Injury Reporting Procedure Your business is very important to us, and we're dedicated to providing you with the resources you need to help you be as successful as possible. Toward that end, Paychex Business
More informationWorkers Compensation Claim Management and Reporting
Workers Compensation Claim Management and Reporting 1 Managing Workers Compensation Roles and Responsibilities Timely Triage and Reporting Key Items for reporting claims Medical Management Return-To-Work
More informationA Guide for the General Practitioner: Ethical Issues When Evaluating, Selecting and Handling Personal Injury Case I.
A Guide for the General Practitioner: Ethical Issues When Evaluating, Selecting and Handling Personal Injury Case I. Finding the Case: For the general practitioner of law, most personal injury claims come
More informationINJURY INFORMATION WORSHEET
APPENDIX A INJURY INFORMATION WORSHEET PATIENT INFORMATION Patient Name Contact Phone Today s DOB DOI HEALTH INSURANCE - PRIMARY Insurance Co. Name of Insured Benefits Phone# Insured SS# Insured DOB Policy
More informationWhere to Begin 1. What You Need to Know Once You ve Been Injured 2. The People Playing a Role in Your Recovery 5
Where to Begin 1 Contents What You Need to Know Once You ve Been Injured 2 The People Playing a Role in Your Recovery 5 Why You Need a Personal Injury Lawyer 8 Frequently Asked Questions 11 Recovery Diary
More informationINJURED ON THE JOB? A SUMMARY OF THE RIGHTS AND BENEFITS AVAILABLE TO INJURED WORKERS UNDER ILLINOIS LAW
INJURED ON THE JOB? A SUMMARY OF THE RIGHTS AND BENEFITS AVAILABLE TO INJURED WORKERS UNDER ILLINOIS LAW Law Offices ANESI, OZMON, RODIN, NOVAK & KOHEN, LTD 161 NORTH CLARK STREET AT RANDOLPH 21ST FLOOR
More informationproductivityedge managed care services
productivityedge managed care services AIG Domestic Claims, Inc. (AIGDC) offers customers a distinct advantage in combating workers compensation costs Productivity Edge. Productivity Edge provides companies
More informationAccident Claim Filing Instructions
Accident Claim Filing Instructions Page One Filing Instructions Complete the appropriate sections of the claim form (page 2) Attach an itemized billing from your provider which includes the date of service,
More informationMaritime Injury Cases
Mailing Address: P.O. Box 34538 Seattle, WA 98124-1538 Maritime Injury Cases The following are the questions most frequently asked by our clients about Maritime injury cases. Obviously, the questions and
More informationDC BAR Non-profit Insurance Webinars
PRESENTATION TITLE DC BAR Non-profit Insurance Webinars Webinar 3 Filing An Insurance Claim Date: January 12, 2011 Presented by: Erica Dominitz and Carl Salisbury, Kilpatrick Townsend LLP Tecla Pinto,
More informationTOWN OF CENTREVILLE PROPOSAL PACKAGE INSURANCE BROKERAGE FIRM WORKERS COMPENSATION MAY 2016
TOWN OF CENTREVILLE PROPOSAL PACKAGE INSURANCE BROKERAGE FIRM WORKERS COMPENSATION MAY 2016 CONTACT: Krystel Ebaugh, Human Resources Specialist 101 Lawyers Row Centreville, MD 21617 401-758-1180 kebaugh@townofcentreville.org
More informationInformation for Worker s Compensation Clients
Information for Worker s Compensation Clients Overview of the Worker s Compensation Act Indiana Worker s Compensation cases are governed by a State law known as the Worker s Compensation Act. The legislature
More informationSedgwick manages injury claims from start to finish with proven strategies that produce better outcomes for clients and injured workers.
CLAIMS AND CARE MANAGEMENT SOLUTIONS Sedgwick manages injury claims from start to finish with proven strategies that produce better outcomes for clients and injured workers. As the leader in customized
More informationCall (206) 477-3350 M F 8:00 a.m. to 4:15 p.m.
Section 29: REPORTING WORK-RELATED ACCIDENTS, INJURIES AND ILLNESSES INTRODUCTION This procedure applies to all King County employees, and includes jurors, witnesses, and all reserve Sheriff s Deputies.
More informationThe Hartford s California Workers Compensation Medical Provider Network (MPN)
Employer Notification Guide Topics Covered are: Workers Compensation MPN Networks in CA New MPN Employee Notification Documents and Processes How It Works The Employer s Role Notification Steps Dealing
More informationWorkers' Compensation in Oklahoma Employer s Rights & Responsibilities
Workers' Compensation in Oklahoma Employer s Rights & Responsibilities Workers Compensation Court Counselor Program 1915 N. Stiles Avenue, Oklahoma City, OK 73105 210 Kerr State Office Bldg, 440 S. Houston,
More informationWorkers' Compensation in Oklahoma Employer s Rights & Responsibilities
Workers' Compensation in Oklahoma Employer s Rights & Responsibilities The information provided in this pamphlet is general in nature and for informational purposes only. It is not intended to be a legal
More informationLOS ANGELES UNIFIED SCHOOL DISTRICT POLICY BULLETIN
TITLE: Workers Compensation Claims Reporting ROUTING NUMBER: ISSUER: Ref-1279.1 Enrique G. Boull t, Chief Operating Officer Office of the Chief Operating Officer All Employees All Locations DATE: November
More informationLOS ANGELES UNIFIED SCHOOL DISTRICT Reference Guide
LOS ANGELES UNIFIED SCHOOL DISTRICT Reference Guide TITLE: NUMBER: REF - 1279 Workers Compensation Procedures ROUTING All Administrators All Locations ISSUER: DATE: September 3, 2004 David Holmquist, Director
More informationWesley Mission Income Protection Claim Form
Wesley Mission Income Protection Claim Form INCOME PROTECTION CLAIMS In order to alleviate any delay in the processing time of your claim, please ensure the following: The claim form is returned with all
More informationMEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE
MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE Complete this form if you are a MEDICAL BENEFITS SETTLEMENT CLASS MEMBER seeking to exercise a BACK END LITIGATION OPTION. In addition to
More informationNSU Employee Manual. Workers Compensation System Guide
Workers Compensation System Guide 1 NSU Employee Manual For more information regarding prevention of risk visit our website at http://www.nova.edu/cwis/fop/risk/ Table of Contents Florida Guidelines -
More informationSarah Mariani v. Kindred Nursing Home (November 2, 2011) STATE OF VERMONT DEPARTMENT OF LABOR
Sarah Mariani v. Kindred Nursing Home (November 2, 2011) STATE OF VERMONT DEPARTMENT OF LABOR Sarah Mariani Opinion No. 34-11WC v. By: Phyllis Phillips, Esq. Hearing Officer Kindred Nursing Home For: Anne
More informationLIFE INSURANCE CLAIM
LIFE INSURANCE CLAIM Life Insurance Claim - Instructions 1. For a Life Insurance Claim: The beneficiary (claimant) should complete the Beneficiary s (claimant s) Statement and submit the completed claim
More informationAppendix A. CAR Special Investigative Units Standards
Appendix A CAR Special Investigative Units Standards The reduction of insurance fraud, by monitoring and coordinating the investigation of suspicious claims, is an important goal of Commonwealth Automobile
More informationCar Accident Representation in New Jersey. Personal Injury in Automobile Collisions in NJ.
Car Accident Representation in New Jersey. Personal Injury in Automobile Collisions in NJ. Kenneth Vercammen & Associates Law Office helps people injured due to the negligence of others. We provide representation
More informationVIRGINIA ACTS OF ASSEMBLY -- 2015 SESSION
VIRGINIA ACTS OF ASSEMBLY -- 2015 SESSION CHAPTER 585 An Act to amend and reenact 38.2-2206 of the Code of Virginia and to amend the Code of Virginia by adding in Article 7 of Chapter 3 of Title 8.01 a
More informationSun Life Assurance Company of Canada
Sun Life Assurance Company of Canada Death Benefits Claim Packet Instructions for the Plan Administrator In the event of the death of an insured employee or dependent, please follow these steps as soon
More informationINSURANCE RESOURCES GROUP LIFE SETTLEMENT APPLICATION
The information herein will be held in the strictest confidence. INSURANCE RESOURCES GROUP LIFE SETTLEMENT APPLICATION INSURED S INFORMATION Insured s Name: Social Security #: - - Street Address: (No PO
More information304.9-430 Independent, staff, or public adjuster's license -- Application by individual or business entity -- Qualifications -- Evidence of financial
304.9-430 Independent, staff, or public adjuster's license -- Application by individual or business entity -- Qualifications -- Evidence of financial responsibility -- Exceptions to license requirement
More informationManaged Care Program
Summit Workers Compensation Managed Care Program KENTUCKY How to obtain medical care for a work-related injury or illness. Welcome Summit s workers compensation managed-care organization (Summit MCO) is
More informationWORKER S COMPENSATION TREATMENT AUTHORIZATION FORM
FLORIDA TECH EMPLOYEE ACCIDENT/ INJURY REPORT Contact Financial Affairs @ 674-7297 OR 8885 IMMEDIATELY regarding an Employee's Injury. Employee AND Supervisor must complete this report. EMPLOYEE INFORMATION
More informationUNDERSTANDING YOUR PROPERTY DAMAGE CLAIM
UNDERSTANDING YOUR PROPERTY DAMAGE CLAIM A LET US EMPOWER YOU This brochure will empower you with the knowledge and tools necessary to complete your own property damage claim. One of the biggest inconveniences
More information10. Does the Applicant manufacture, store, distribute, sell, handle or transport any of the following?
INDEPENDENCE AMERICAN INSURANCE COMPANY a Delaware Insurance Company Administrative Office: 485 Madison Avenue, 14 th Floor, New York, NY 10022 Contractual Liability and Employers Liability Application
More information