Workers’ Compensation Claims Handling Guidelines • Contact with the primary medical provider must be made within 8 hours of receipt of the claim. Written, the telephonic, electronic transmission will satisfy the 8-hour contact requirement. • If initial contacts are unsuccessful on day 1, the Workers' Compensation Claim Specialist must follow up either by phone, email, or text the next business day. If contacts have not been achieved by day 3, the Workers' Compensation Claim Specialist will mail a contact letter to the employer and injured worker. • Incident Only claims may not have a 3-point contact. • The file must contact either a "Contact Achieved" or a "Contact Effort" entry. The claims must indicate "Contact Achieved." If unable to make contact, the tree must reflect "Contact Not Applicable." Initial Investigation - Compensability • The Workers' Compensation Claim Specialist should take a recorded statement on all lost time files and questionable medical only claims, any claims involving potential subrogation, or at the client's request. Witness statements should be obtained as needed. • When applicable, wage statements, a job description, and supplemental reports should be requested from the employer and are required on all indemnity claims. The Workers' Compensation Claim Specialist must calculate the disability benefit based on the AWW, TTD, TPD, PPD, and PTD rates. o Wage statements must be requested within 24 hours of known indemnity exposure. Indemnity exposure includes Temporary Total Disability, Temporary Partial Disability, Permanent Partial Disability, Permanent Total Disability, Death Benefits, and Settlement. o Subsequent requests shall be made every 48 hours until the appropriate wage statement and/or loss earning documentation has been received. If, after 3 requests, the wage documentation has not been received, the Workers' Compensation Claim Specialist must file a risk alert with the client. o The benefit calculation shall be documented in C3 under the "Wage/Income Loss" Category. The Workers' Compensation Claim Specialist must also link the wage statement and or loss earning documentation to the file note entry. • Until the Workers' Compensation Claim Specialist has successfully completed the applicable jurisdictional wage statement training assessment, all AWW must be validated by the Unit Manager. The Unit manager must document their findings in the claim system. Once the Workers' Compensation Claim Specialist has successfully completed the assessment, they are no longer required to seek unit manager validation. However, the unit manager may continue to require validation at their discretion. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.