C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W 14-DAYS a COMPENSABILITY y U W Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. nit MC C anagr Abbreviated Template edo f eror • Under investigation: Currently, compensability is pending. Need to secure employer and/or injured worker’s s f statement. Compensability will be updated once the investigation has been completed. orW SC C Full Template pecialistsr edo • Jurisdiction: • Employment Description: • Accepted Body Part(s): P r acticB • Accident Description: es est • Diagnosis: • Causal Relationship: U Example: Rationale for Compensability Checklistnit M The injured worker did meet the definition of an employee and was in the course and scope of their employment when anag injured. The injured worker is eligible for workers’ compensation benefits. (Do not use the word DENY…eligible or not er eligible) ChecklistSW OPTIONAL: You can add what the injured worker was doing when injured if you want. pecialist C Claims EX: Injured worker was stocking the liquor shelves and received a laceration for the webbing between her ring finger and the pinky finger. Two examples: 14 DExpecta F a tionsile This file is eligible for benefits under workers’ compensation. The injured worker is a janitor who was mopping the y school floors when she turned and heard a pop in her back, sustaining a low back injury to the L5-S1 level. As the s injured worker was in the course and scope of her employment with Brookview Elementary by performing janitorial duties on-site, this file is accepted as compensable under Nebraska Workers’ Compensation. Expecta F This file is not eligible for benefits under Iowa jurisdiction based upon the idiopathic condition as the injured worker tionsile fainted while walking down the hallway at work. The syncopal episode is related to the injured worker’s health condition and not her employment. The file is not eligible for workers’ compensation benefits under Iowa Workers’ Compensation. R e f er D *If the employee is not eligible for benefits, please make sure there is authority from a leader on file to notify of the encisability ineligibility of benefits. e G uide CaN t o egt orieses and 16 17