When a work-related injury occurs, the most important thing to do is to get the injured worker medical treatment as soon as possible. Also, complete a BWC First Report of Injury (FROI) form with the injured worker and submit it to your managed care organization as quickly as possible.

In order to ensure that the claim is handled properly we have provided a checklist to help you in the claim process.

• Incident investigation report completed
• Did the associate follow the incident reporting policy?
• Coaching, counseling, or disciplinary action 
• Copy of First Report of Injury (FROI) in your file & sent to MCO
• Initial contact with MCO to alert them of the claim & verify the information has been entered
• Initial contact with TPA if any of the following apply:
  • Associate will miss more than 7 calendar days of work
  • You are considering rejecting the validity of the claim
  • The injured worker is not your employee
  • The injured worker hasn’t been released to full duty (FD)
• Decision was made on certifying or rejecting the claim (contact TPA if rejected)
• Decision was made if transitional work (TW) is available & sent copy of TW job description to MCO & TPA
• Decision was made on paying salary continuation or having BWC pay temporary total (TT) compensation
  • If paying salary continuation (injured worker (IW) will miss 8 or more days): wage sheet filled out (wages needed for one year prior to date of injury) & sent to BWC & TPA
  • If BWC will pay TT compensation (IW will miss 8 or more days): wages submitted to BWC
• Supporting documents such as witness statements & supervisor notes collected (copy to TPA)
• MEDCO 14 on file (Return to work, restrictions, off work, healthcare provider's name & address of healthcare facility). A new Medco 14 should be requested after the last one on file expires.
• A TW job offer was sent via certified mail as soon as the associate is released to return to light duty work.
• Release to full duty on file (if not part of the MEDCO 14)
• Healthcare provider notes on file which outline the injured worker's injury or illness, mechanism of injury, assessment, treatment plan, prescriptions, etc.
• Verification that drug test was performed (if applicable.)
• Copies of any documents from BWC, MCO, or TPA and decisions on appeals
• Keeping the MCO, TPA, & BWC up-to-date on the progress
• Contact with associate, supervisor, MCO, TPA & BWC
• OSHA/PERRP recordability determination (medical only, restricted activity, lost time)
• OSHA/PERRP 300 log filled out and/or updated

Remember:

• It is critical that to have a complete history of treatment and dates from the beginning of the incident to the release to full duty.
• During initial contact with the MCO, verify the healthcare provider has entered the information to start the claim. If they have not, your MCO must enter the information.
• Workers' compensation lost time is after 8 days away from work, but OSHA/PERRP lost time is any day after the day of injury.
• The treatment plan outlined by the healthcare provider must be followed, especially in regard to restrictions.  If something is not clear, contact the healthcare provider or MCO for clarification.  If the healthcare provider returns the associate to work, the associate must return or obtain revised documents from the healthcare provider.  They are administratively absent until they do so.

For questions or additional information please contact Jim Wirth, 614.546.7331, ext 4, jim.wirth@sedgwick.com.