tecis

Workers' Compensation Claim Reporting Instructions

When an injury occurs, please follow these instructions completely:

1. Complete "Employer's First Report"
2. Any statement on behalf of the employee about the cause of injury should be preceded by the wording "employee alleges"
3. Call in the First Report of Injury immediately to Gallagher Bassett: For Sparta related Claims (800) 824-3313; For Amtrust/Security National Insurance Claims (866) 908-7241
4. Immediately notify TECIS of any fatalities or catastrophic injuries.

Important Information

When an employee is injured on the job:

1. Get immediate medical attention from an approved doctor.
2. Immediately complete the First Report of Injury
3. All medical bills and documentation should be forwarded directly to Gallagher Bassett for review and payment. Do not hold doctor's reports or medical bills; forward them as soon as received.
4. If lost working time develops after you have submitted the "Employer's First Report", be sure to advise your Gallagher Bassett adjuster. Wage statements for lost time cases must be completed immediately and forwarded to Gallagher Bassett. Also, prompt notification when an employee returns to work will help reduce costs by proper termination of benefits.

Suggestions to Help Expedite:

Remember, your employee may have to depend on compensation benefits to replace wages or salary. Payments cannot be made until you notify Gallagher Bassett.

1. Be sure all portions of the "Employer's First Report" are completed, if possible. Special attention should be given to data on employee and injury.
2. The "Employer's First Report" should be completed and signed by employer or representative, not employee.
3. Check medical bills and reports before sending to insurance carrier to make sure employees' name and employer are readily identifiable.
4. In many states the employer has the right to select the doctors from whom injured workers' can seek services. Don't compromise your rights as an employer from the start. You may check with Gallagher Bassett for a list of approved doctors.
5. Failure to report promptly could result in fines being levied against your company.