After An Injury

Workers’ compensation laws vary by state. The following is a general overview of the workers’ compensation claims process common to most states. Please see the benefits section for links to benefit information specific to your state.    
 
If you are injured while on the job, you should get appropriate first-aid or medical treatment as soon as possible.
 
To report an injury, you should: 
 
1. Immediately report the incident to your employer. Your employer will report your claim to us.
2. Seek immediate medical or first-aid treatment. In some states, your employer may require you to obtain initial treatment from a designated medical provider. If your employer does not have a designated medical provider, we ask that you seek treatment for all non-emergencies at one of our preferred provider organization (PPO) facilities, if available. For life-or-limb-threatening injuries, please seek initial treatment from the nearest medical facility.
3. Inform your treating physician that you were injured in a work-related accident and tell the physician your employer is insured with WCF Insurance.
4. Seek ongoing treatment at the designated medical provider or at one of our PPO facilities, if available. If you are considering seeking care outside of a designated medical provider, please contact your adjuster for additional information
5. Promptly provide information we request and cooperate with our investigation of your claim.
6. Contact your claims adjuster to determine which medical services must be preauthorized by your physician.
7. Keep your claims adjuster and your employer informed of your progress and when you will be able to return to work. Keep them updated on any changes in your employment status, address, or telephone number.
8. Be honest in reporting your injuries and capabilities. We work to protect you and your employer against fraud. Collecting workers’ compensation benefits through fraudulent pretenses, misrepresentations, or omissions is illegal and the penalties for doing so can be severe.  
 
OUR RESPONSIBILITY
 
1. We will set up a claim upon receipt of either the employer's report of injury or the physician's report of injury.
2. We will send you a letter acknowledging receipt of your claim. This letter contains important information, including your claims adjuster's name and phone number, and your claim number. Include your claim number on all correspondence.
3. If it appears you will need time off work to recover, your adjuster will contact you within two business days of receiving your claim.
4. We will conduct a fair and thorough investigation of your claim in a timely, professional manner. As a normal part of our investigation, we regularly request you provide us with a recorded statement and a signed release authorizing us to obtain your prior medical records.
5. We will process your benefits in a fair and timely manner. If your doctor has you temporarily off work and provides us appropriate documentation, you will be paid compensation pursuant to state law.
6. We will contact you periodically to see how you are progressing.
7. We will monitor your medical treatment and progress to ensure you are receiving appropriate care for your injury. We may assign a nurse case manager to aid in the process.
8. If the law in your state provides for vocational rehabilitation and you qualify, then we will assign a vocational rehabilitation counselor to aid you in returning to work.
 
We understand this is an unfamiliar experience for you and that you will have many concerns regarding your claim and recovery. Your claims adjuster is available to answer any questions you may have.  You may also find additional information about workers’ compensation benefits in your state here.
 
 

 

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Insurance coverage in all states other than Utah is provided by Advantage Workers Compensation Insurance Company, a wholly owned subsidiary of Workers Compensation Fund, doing business as WCF Insurance.
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