First steps - injury reporting and best practices 
By Lance Watkins, VP, client services, Sedgwick MCO

The initial filing of a workers’ compensation claim can be overlooked in its importance to the claim process and contribution to the eventual outcome of a claim.  The highest priority with any workplace injury is to ensure that the employee’s medical needs are met and that any safety hazards are quickly addressed. 

But quickly organizing a new claim with clear information from the start helps simplify the experience for both the employer and the injured employee. 

Required information
In order to simply put a new claim on file with the BWC, there are only four data elements required: 

• BWC policy number
• Injured worker’s name
• Injured worker’s home address
• Date of injury

This seems simple enough, but a common stumbling block is the accuracy of the employer’s policy number.  If a new claim is initiated by the treating medical provider, the correct policy number may not be readily available.  Medical offices can use the BWC website to search for the policy number, but this is not foolproof.  For example, if the employer name is common (like “McDonald’s”) or if multiple policies are affiliated under a common name or parent organization, the claim can be assigned to an incorrect employer policy.

Additional required information
Before the BWC can make an allowance decision, there are several additional data elements that must be added to the claim file.  Not every data element will be known at the time of the incident, such as medical diagnosis or return-to-work date.  But collecting as much information as possible at the outset can help the BWC make better decisions on claim allowance and make those decisions more quickly.  Those additional data elements include:

Claim data collection

One of the roles of a Managed Care Organization (MCO) is to facilitate this initial claim filing process by collecting and verifying these data elements.  If you have been involved in the handling of a workplace injury, you may be familiar with your MCO’s effort to collect and confirm this information.  The first four pieces of information needed for initial filing are the most time sensitive.  However, the MCO is required to seek the additional information throughout the claim process.  Communication with the employer, injured employee, and treating medical facility is essential to this effort.

Injury reporting – best practices
The claim filing process depends on information from multiple parties, including the injured employee and the treating physician.  But we encourage employers to take action as quickly as possible after a workplace incident to control this vital early stage of the process.  Establishing post-injury protocols that include thorough documentation of the incident, as well as compiling information required by BWC, can accelerate a sound claim allowance decision.  Early clarity on the nature of incident and injury can help frame the scope of the claim and define the medical conditions that are included for treatment. 

The First Report of Injury (FROI) is the standard BWC form that accommodates the required information and typically initiates a new claim.  Many employers keep the FROI on-hand to serve as an incident report.  Sedgwick Managed Care Ohio will provide clients with an Injury Reporting Packet, which can include the FROI and other forms and information to help guide both the employer and the injured employee through the claim process. 

Many employers have developed an incident report that collects much of the information required for the workers’ compensation claim.  Consider modifications to your incident report that may facilitate a more efficient claim filing process.  One of the best things an employer can do to promote speed and accuracy in claim filing is to have an incident report completed quickly and sent directly to the managed care organization.

Options for claim filing
The incident report or FROI can be submitted directly to your MCO.  If you are with Sedgwick Managed Care Ohio, you have the following options for submitting claim documentation:

• Fax: 888.711.9284
• Call-in: 888.627.7586
• Email: Incident@Sedgwickmco.com
• Online: Sedgwickmco.com  (resource.sedgwickmco.com)

For more details on injury reporting contact your MCO or if you have Sedgwick MCO as your MCO please feel free to reach out to them at ClientServices@Sedgwickmco.com.