CLAIMS PROCEDURES
Procedures to Follow When an Injury Occurs
1. The supervisor should immediately complete an accident report. If this cannot be done as soon as the injury occurs, it should be completed and signed by the employee as soon as the employee returns to work.
2. Investigate all accidents thoroughly. If the investigation reveals that the injury did not occur as stated by your employee, obtain signed statements/affidavits from the witnesses or supervisors involved. If possible, have the statements/affidavits notarized.
3. When the employee obtains medical treatment, he/she may complete a First Report of Injury (FROI) form which is the BWC’s claim application, at the medical facility. The medical facility will then send this information to your MCO. You may be contacted by your MCO before you have started your investigation. It is important that the employee complete and sign the accident report, and FROI application.
4. It is important to let your employees know which MCO you have selected. If your employee was not provided an ID card prior to obtaining medical treatment, you should contact the medical facility with the name of the MCO representative.
5. The MCO may request your decision on certification or rejection of the claim. The MCO cannot force you into certifying a claim. If you feel the incident or condition is questionable, inform your MCO. The MCO will still medically manage the claim, advising the employee the bills may be his/her responsibility if the claim is denied.
6. The MCO will probably ask you for a copy of the accident report and any medical reports you may have. This information must be sent to the MCO and BMSO within 24 hours of the injury.
7. Once the MCO has completed the initial evaluation of the claim, the information is sent to BWC. BWC will generate a form letter to you asking for certification or rejection of the claim if they do not already have this information on file.
8. The provider, MCO and BWC may all have different information on how the injury occurred. For this reason, your accident report may be the only form with the injured worker’s signature.
9. When in doubt, do not certify questionable claims. Contact your BMSO representative for instructions.
10. Upon receipt of hearing notices, contact your service representative to ensure all facts are presented prior to the hearing.
11. A copy of all correspondence from BWC, IC, your MCO, attorneys, etc. should be sent to BMSO to ensure proper and timely filings.
BWC Notification of Handicap Conditions
BWC may provide the employer handicap relief in their claims experience with claims involving a pre-existing handicap condition which caused a delay in the healing process or contributed to the cost of the claim. The relief is granted through the hearing process and will be initiated by BMSO.
If you do not have records on handicaps, we recommend you have all your employees complete and sign a Handicap Listing form and thereafter make the form part of your new hire orientation packet.
Hearing Attendance
Arrangements have been made by BMSO to receive copies of all notices of hearings. Occasionally, the IC hearing notices will not list BMSO as the representative. A copy of all hearing notices that do not show BMSO as your representative, should be faxed to our office IMMEDIATELY. Our fax number can be found on the contact page.
Our success depends partly upon the preparation of evidence available at the time of the hearing. All relevant medical documents, investigation reports and witness statements must be provided to BMSO prior to scheduled hearings.
If you feel your interests can best be served by your attorney on a particular claim, BMSO will continue to administer the claim; however, BMSO may not attend the IC hearings.
A representative of your company may be required to attend a hearing if circumstances warrant. You will be notified in advance should attendance be required.
Either a written report or claim abstract report will be sent to you explaining what transpired at each hearing. BMSO will file all necessary appeals and relevant motions in the best interest of the employer.
BMSO also has a staff of attorneys available to represent our clients, upon request. Contact your BMSO representative for additional information.
Correspondence From BWC
Send BMSO a copy of ALL correspondence received from BWC which does not show or list BMSO as your representative.
Correspondence From Attorneys
Attorneys may send letters directly to you requesting information on wages. This information should be sent directly to the BWC with the completed form sent to the attorney. Forms C94A may be used for this purpose.
Attorneys may send settlement offers directly to you. If you would like BMSO to negotiate the settlement on your behalf, forward the settlement form to BMSO.
Although BMSO does not participate in civil court matters, you should send a copy of all correspondence you receive from attorneys regarding the claim in litigation to ensure our files are complete.
Hearing Notices
The BWC/IC issues hearing notices to determine the allowance or denial of claims, further allowances, treatment and other issues.
It is imperative that you fax or mail a copy of the hearing notice directly to BMSO upon receipt if BMSO is not listed as your representative.
BWC Orders/IC Orders
The Bureau of Workers’ Compensation or the Industrial Commission will issue formal orders which allow or deny claims, further allowances, treatment, etc.
It is imperative that you fax or mail a copy of the order to BMSO upon receipt of the order, even if BMSO is listed as your representative.
BMSO’s mailing address, telephone number and fax number can be found on our contact page.
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