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BusinessWC Process
By clfillmore
Category: Business. Viewed 386 times. Created January 2015.     Disclaimer.   
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Workers' Compensation Process

A work injury occurs.
Employee reports injury to manager, then goes to Occupational Medicine for evaluation and treatment.
Occupational Medicine treats employee and determines if offsite evaluation may be necessary.
Employee is given First Report of Injury or Illness to fill out and return to WC Case Manager in Legal or given to personnel in Medical to forward to Legal.
Entry of FROI is made into Third Party Administrator (TPA) web-based system by WC Case Manager.

Employee is given temporary work or released to full duty.
Adjuster may request additional information from employee during claim.
Medical provider contacted for information if necessary.
Adjuster sends required benefit notices and approves medical treatment as appropriate.
Adjuster calls employee and employer to set up claim and verify eligibility for benefits.

If employee is unable to work, claim status will change and benefits will be paid. WC Case Manager coordinates benefits payments and BEA time loss.
Work status is monitored and coordinated for modified duty through full release.
Employee is released to full duty.
Upon release from care, employee is sent a closing letter.
Claim file is closed. Occupational Medicine may close file prior to TPA closing of file.