WORKERS COMPENSATION. Claims Kit
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1 WORKERS COMPENSATION Claims Kit
2 Dear Customer, Thank you for choosing ProSight Specialty Insurance as your Workers Compensation Insurance carrier. We pride ourselves on providing excellent service and will do our very best to meet your Workers Compensation Claims needs. ProSight Specialty Insurance writes our Workers Compensation policies through our New York Marine and General Insurance Company underwriting company, which is the name you will see listed on your policy. ProSight has partnered with a leading Workers Compensation claims service provider, Gallagher Bassett Services, to assist us in the administration of claims. Gallagher Bassett will be your primary point of contact for claims. To determine which office will be handling your claims, please refer to the map included with this packet. Please make sure to include your Policy Number on all correspondence. For your convenience, the following documents can be found inside your claims kit: Instructions on how to report a claim Claim Handling Map List of Claim office locations, mailing addresses, and claim contacts How to locate a Physician Pharmacy cards Links to your state s Workers Compensation forms and Web Pages Please do not hesitate to contact us should you have any questions or concerns. Workers Compensation Claims Department ProSight Specialty Insurance 412 Mt. Kemble Avenue Morristown, NJ claimsinquiry@prosightspecialty.com Phone: Fax:
3 Need to Report a Claim? By claims@prosightspecialty.com By phone: (800) Press 1 to report a claim (Available anytime- days, nights & weekends) By fax: (800) Press 2 to inquire about a claim (Available 8:00am to 5:00pm EST) By Mail: ProSight Specialty Insurance Claims Department 412 Mt. Kemble Avenue Suite 300C Morristown, NJ Additional Instructions: Online: -. EXPERIENCED PROFESSIONALS. INSIGHTFUL SOLUTIONS.SM
4 Workers Compensation Claim Handling Washington Montana North Dakota New Hampshire Vermont Maine Oregon Nevada California Idaho Utah Arizona Wyoming Colorado New Mexico Minnesota South Dakota Wisconsin Nebraska Iowa Illinois Kansas Missouri Oklahoma Arkansas Michigan Ohio Indiana Kentucky Tennessee New York Pennsylvania West Virginia Virginia North Carolina South Carolina New Jersey Delaware Maryland Massachusetts Rhode Island Connecticut Mississippi Alabama Georgia Alaska Texas Louisiana Hawaii Florida ProSight Specialty Insurance Gallagher Bassett Services LWP Claims Solutions Monopolistic
5 Claims Handling Offices ProSight Specialty Insurance Mailing Workers Compensation Claims Department ProSight Specialty Insurance 412 Mt. Kemble Avenue Morristown, NJ Phone: Fax: Alabama Arkansas California Colorado Connecticut Delaware DC Florida Georgia Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Massachusetts Michigan Minnesota Missippi Missouri Nebraska New Hampshire New Jersey New York North Carolina Pennsylvania Rhode Island South Carolina South Dakota Tennessee Utah Vermont Virginia West Virginia Wisconsin WC Claims Manager: Melissa Kovacsy Lost Time Adjuster: Patrick Gano Medical Only Adjuster: Melinda Bullock
6 Mailing Claims Handling Offices Alaska Wilton Adjustment Service, Inc E. 34th Avenue, Suite 400 Anchorage, AK Phone: Fax: Alaska Branch Manager: Joanne Pride, x 3412 joanne-pride@wiltonalaska.com Adjuster: McKenna Wentworth, x 3452 mckenna-wentworth@wiltonalaska.com Medical Only: Shea Loescher, x 3317 shea-loescher@wiltonalaska.com
7 Claims Handling Offices Arizona Mailing Gallagher Bassett Services- 007 (Phoenix) PO Box Scottsdale, Arizona Arizona Phone: Fax: Toll Free: Branch Manager: Bruce Martin
8 Claims Handling Offices Hawaii Mailing Gallagher Bassett Services Fort Street, Suite 420 Honolulu, HI Phone: Fax: Toll Free: Hawaii Nadine Kurihara-Nakasu, Branch Manager
9 Claims Handling Offices Idaho Mailing Gallagher Bassett Services East Park Blvd., Suite 125 Boise, ID Phone: 208/ Fax: 208/ Toll Free: 866/ Idaho Regina Pearson, Branch Manager
10 Claims Handling Offices Montana Mailing Gallagher Bassett 080 (Missoula) 2501 Catlin Street, Suite 200 Missoula, MT Phone: Fax: Montana Regina Pearson
11 Claims Handling Offices Nevada Mailing Gallagher Bassett Services 156 P.O. Box Las Vegas, NV Phone: Toll Free: Fax: Nevada Charles Rostad, Branch Manager (UPS, Federal Express, etc) 2110 E. Flamingo Road, Suite 314 Las Vegas, NV 89119
12 Claims Handling Offices New Mexico Mailing Gallagher Bassett Services Louisiana NE, Suite 220 Albuquerque, NM Phone: Fax: Toll Free: New Mexico Regina Pearson, Branch Manager Regina_Pearson@gbtpa.com
13 Claims Handling Offices Oklahoma Mailing Gallagher Bassett Services Waterford Blvd., Suite 120 Oklahoma City, OK Phone: 405/ Fax: 405/ Toll Free: 800/ Oklahoma Stacy Goble, Branch Manager Stacy_Goble@gbtpa.com
14 Claims Handling Offices Oregon Mailing Gallagher Bassett Services 155 (Portland) 4550 Kruse Way, Suite 155 Lake Oswego, OR Phone: Fax: Toll Free: Oregon Eric Sorem, Branch Manager
15 Claims Handling Offices Texas Mailing Gallagher Bassett Services (Dallas) 6404 International Parkway, Suite 2300 Plano, Texas Phone: Fax: Toll Free: Texas Terry Tarter, Branch Manager Terry_Tarter@gbtpa.com
16 Navigating the Coventry Medical Provider Directory Website Use this search tool to locate Medical Providers ONLY If your claims are administered by Gallagher Bassett Go to Enter Login ID: GBMCS A new page will appear, click on the link Channeling Tools The next page will give you four options to choose from: Address Search: This option is a radius search from a centralized address. Name Search: Allows the user to look up a certain provider in the database by name or phone. Region Search: This option allows the user to search in a specific region such as city, county, zip code, etc. Quick Search: A search using a limited number of specialties for providers who provide initial treatment to a maximum radius of 35 miles around an address. Creates output to a custom Worksite Poster or Directory. Worksite Posters: This option allows the user to make a Worksite Poster with the closest network providers while following all jurisdictional regulations and guidelines. ADDRESS SEARCH Begin by selecting the Network you wish to search. Enter your address. You must enter at least a valid ZIP Code or a City/State combination. At the bottom of the page you may choose: Provider Types, Specialties and/or distance. Once you click on find providers your results will be displayed. NAME SEARCH Use the Name Search tab if you already know a Provider s name, group affiliation or phone REGION SEARCH Use this feature if you are searching for a provider in a specific area. QUICK SEARCH Use this tab if you are searching for ONLY one of the following: Family Practice, Internal Medicine, Occupational Medicine, Emergency Medicine and Occupational Medical Clinics within 35 miles of a specific address. WORKSITE POSTER (WSP) This page is used to create Worksite Posters or batches of Posters. For your convenience, you can upload your Locations and create your posters!
17 Temporary Prescription Services ID For Claims Administered by Gallagher Bassett Attached you will find a prescription form (also called a temporary pharmacy card) that must be given to each and every employee when there is an on the job injury. Employees simply call the First Script number to locate a local pharmacy where they can get their Workers Compensation prescription(s) filled. It is a good idea to distribute these forms to your Supervisors, Team Leaders, and your Human Resources department so they are familiar with the form. Chances are they will receive the notices of injury and will likely be responsible for handing the form to the injured employee.
18 PRESCRIPTION PROGRAM FOR WORK-RELATED INJURIES ProSight Specialty Injured Worker No Cost STEP 1 STEP 2 No Delay Feel Better Faster Pharmacy Instructions Medco Pharmacy: You will not be required to submit any paperwork for this claim and payment is guaranteed for all electronically accepted claims. Pharmacy: (Above information to be completed by injured worker or supervisor) MEDCO FSNCVTY
19 Programa de Beneficio Farmacéutico Para Accidentes Laborales ProSight Specialty Empleado Lastimado Ningún Costo Paso #1 Paso #2 Sin Tardanza/ Sin Demora Siéntase Mejor Mas Rápido Pharmacy Instructions Medco Pharmacy: You will not be required to submit any paperwork for this claim and payment is guaranteed for all electronically accepted claims. Pharmacy: (Above information to be completed by injured worker or supervisor) MEDCO FSNCVTY ProSight Specialty
20 Dear Policyholder: For your convenience, we have included the following website addresses to your state s Workers Compensation web page. From the links below, you can access any forms that you might need when submitting a Workers Compensation claim. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
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HAWAII () IDAHO () Illinois () MAINE () Maryland () MASSACHUSETTS () NEBRASKA () NEVADA (Carson ) NEW HAMPSHIRE () OHIO () OKLAHOMA ( ) OREGON () TEXAS () UTAH ( ) VERMONT () ALABAMA () COLORADO () INDIANA
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Rates are valid through March 31, 2014.
The data in this chart was compiled from the physician fee schedule information posted on the CMS website as of January 2014. CPT codes and descriptions are copyright 2012 American Medical Association.
State Specific Workers Compensation Guidelines Employer Direction of Medical Care
Alabama - Employer/insurer choose the treating provider without restriction. The employer/insurer cannot change providers after the initial selection. The employee can change providers once. However, the
22 States do not provide access to Chapter 9 Bankruptcy
22 States do not provide access to Chapter 9 Bankruptcy -Georgia explicitly denies access to municipal bankruptcy. (GA Code 36 80-5) States with No Statutes: Alaska Delaware Hawaii Indiana Kansas Maine
Hail-related claims under comprehensive coverage
Bulletin Vol. 29, No. 3 : April 2012 Hail-related claims under comprehensive coverage Claims for hail damage more than doubled in 2011 compared with the previous three years. Hail claims are primarily
How To Check If An Employer Is Self Insured For Workers Compensation
Proof of Workers Compensation Insurance Coverage Most states have online verification sites for proof of workers compensation insurance coverage. Several of these are similar in design and are administered
FELONY DUI SYNOPSIS. 46 states have felony DUI. Charts 1 and 2 detail the felony threshold for each of the 46 states analyzed.
FELONY DUI SYNOPSIS The information in the following charts was compiled by examining the felony DUI laws in all 50 sates and the District of Columbia. The analysis focuses on the felony DUI threshold,
2014 Tax Changes. This document currently reflects only tax changes of which ADP was notified by tax agencies as of January 2, 2014.
2014 Tax Changes Beginning with your first payroll with checks dated in 2014, employees may notice changes in their paychecks due to updated 2014 federal and state tax requirements. This document will
July 2012 (1) States With Negative Growth 22 States With Positive Growth 25
Respondent Coverage: 100% July 2012 Current Month Current Month New England 9.5% Connecticut -3.3% Maine 3.6% Massachusetts 24.1% New Hampshire -0.1% Rhode Island 13.3% Vermont -0.3% Middle Atlantic -3.5%