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 Verify the name, age, date of birth, SSN, address, the telephone is correct in Claims System y U W • Confirm the accuracy of the Big Five Data elements during contact with the employee: nit MC C Employee Social Security Number: Verified anagr Date of Birth: Verified edo f Gender: Verified eror First & Last Name: Verified s Address: Verified f orW • Telephone SC C • Height/weight: pecialistsr • Languages spoken: edo • Marital status: • Dependents: • Education & what level: P r • Other training & certificates: Hobbies: acticB • Employer’s name & location: es est • Date of hire/Length of employment: • Supervisor name & title: • Work hours and days worked: U • Wage information: Checklistnit M • Any other current jobs or income: anag • Prior employment history - Employer’s name/ your title/date of employment/ job duties: er • Current job description/duties: • Medical history: • Accident time/date/place: ChecklistSW • To whom and when was injury reported: pecialist C Claims • Witnesses: • How did the injury occur: • Symptoms at the time of injury: • Body parts injured: 14 DExpecta • Date of first treatment: F • Where is IW treating: a tionsile y • Current symptoms: s • Diagnosis: • Next appointment: Expecta • Referred to the doctor by an employer: F • Prior injuries to any body parts to include personal or work-related: tionsile • Was the damage due to a machine, equipment, or another person? If so, obtain details: • Have you RTW? R e If so, full or transitional duty: f erD • Last day worked/the First day of lost time: encisability • Group/health insurer: e G • Medicare beneficiary or applied for SSDI and Medicare: uide • Benefits explained to IW: • Pharmacy card explained to IW: • Preferred Method of Contact? CaN t o egt orieses and 12 13