Workers’ Compensation Claims

employee-benefits

Fill out an Injury Report

Reporting Procedure:

Workers compensation claims are reported directly to your insurance carrier, not to Crum-Halsted. Because time is of the essence in handling workers compensation claims, it is imperative that they are reported to your insurance carrier as soon as possible. Following is a list of the information that you will need to report a workers compensation claim, however, do not wait to report the claim if you do not yet have all of the full details.

Information needed to report a workers’ compensation claim:

  • Name and address of the injured employee
    Date of the injury
  • Circumstances surrounding the injury (how the employee was injured, time of day, equipment involved, etc.)
  • Details on the injury itself (type of injury, extent of injury, etc.)
  • Information on the initial medical treatment
  • Names of any witnesses

Illinois Preferred Provider Program (PPP):

As a part of the 2011 Illinois Workers’ Compensation reform act, Illinois employers will soon have the ability to direct workers injured on the job to specific medical providers through the creation of Preferred Provider Programs (PPPs). Although the act was signed into law on June 28, 2011, in November 2011 the Illinois Workers’ Compensation Commission introduced the required approval process to be a Preferred Provider as well as the employer forms necessary to participate. If you plan to use a PPP, the forms referenced below must be provided to injured workers at the time of a workplace injury and posted throughout the workplace. You can obtain electronic copies of these forms from the Illinois Workers Compensation Commission web page:
www.iwcc.il.gov/PPPadvisoryform.doc & www.iwcc.il.gov/PPPform.doc

  • Notice of Our Workers’ Compensation Preferred Provider Program (PPP): use this form to notify employees of your company’s participation in the approved provider program
  • Notice of Preferred Provider Program for Workers’ Compensation Medical Care: use this form at the time of a workplace injury

We would encourage you to transfer these forms onto your letterhead at this time. We anticipate that the Illinois Department of Insurance will begin to push through PPP medical network approvals in the very near future as it is still in the approval process.

To access the Illinois Department of Insurance website that contains the Approved Workers’ Compensation Preferred Provider Program Administrator List visit: http://www.iwcc.il.gov/faqmed.htm#ppp

There are various ways you can report a workers’ compensation claim depending on the carrier you are with: 1) by fax 2) by phone 3) online 4) via email.

Reporting a workers’ compensation claim by phone:

  • Call the phone reporting number.
  • Give the information that you gathered about the claim to the phone reporting adjuster. Be candid with the adjuster on the phone, and give them any additional information that you believe is pertinent.

This is all you will need to do. The insurance carrier will fill out the state required First Report of Injury on your behalf, file it with the state, and send you a copy.

  • Reporting a workers’ compensation claim by fax:
    Complete the First Report of Injury form (in Illinois, Form 45 – see next page). If you have any additional information that does not fit on the form, type the information on your letterhead and attach it to the injury report.
  • Fax the original report directly to the insurance carrier.
  • Forward a copy of the first report to the state Industrial Commission if the claim involves lost time, broken bones or anything that you feel may amount to a serious problem.

Reporting a workers’ compensation claim by email or online:

  • Complete the First Report of Injury form (in Illinois, Form 45 – see next page). If you have any additional information that does not fit on the form, type the information on your letterhead and attach it to the injury report.
  • Email the original report directly to the insurance carrier.
  • Forward a copy of the first report to the state Industrial Commission if the claim involves lost time, broken bones or anything that you feel may amount to a serious problem.
  • If your carrier accepts online claim reporting, you will complete the First Report of Injury Form via their online system and it will walk you through the require steps

Additional information:

  • As you obtain medical bills and doctors reports, please forward them directly to the insurance company (you do not need to send a copy to Prime Meridian). Please include the name of your company, the employee’s name and injury date, and a claim number, if known, to be sure that the adjuster can match the bills to the proper file.
  • After you report the claim to the insurance company, they will send you a letter or card in the mail that will give you a claim number, and also the adjuster handling the claim. If you used a phone reporting system, they may give this information to you over the phone.
  • If your employee obtains an attorney, you will receive an Application for Adjustment of Claim from the Industrial Commission & Notice of Hearing. The application advises that the employee is seeking a settlement for the injury sustained. This notice advises you when the employee’s case will appear before the Commission. Please forward these IMMEDIATELY to the Insurance Company.