Managing Claims Overview

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Claims Coordinator Responsibilities

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Choose a Medical Provider

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When an Injury Occurs
   Finding Out About an Injury
   Your Five-Step Response
   Report a Work Injury
   Stay in Contact
   Handling Medical Records
   Situations to Watch For

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Report an Injury

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Situations to Watch For

Learn from others' reporting mistakes and save yourself time, money and headaches.

An employee is missing work

If the injured employee is missing time from work, it is crucial to include this on the First Report and notify your SFM claims representative. While lost-time may not be immediately payable, it does trigger states' deadlines for when benefits are due to the employee.

Information changes

If an employee starts missing time from work after you sent the First Report or you find out the employee has moved, call your claims representative immediately with the updated information.

You receive a medical bill

You shouldn't receive any medical bills for an injured employee. If you do, send them directly to CorVel at:

CorVel Corporation
3001 NE Broadway St, Suite 600
Minneapolis, MN 55413

Don't ever pay a bill. This may be an admission of liability.

You question the injury's legitimacy

You may believe an injury is not work-related. Still, by law you must report every claimed injury—even if it's questionable. Reporting an injury does not admit liability. It means an employee claimed an injury occurred at work.

Use confidential comments to note your suspicions or contact your SFM claims representative.

You suspect fraud

Insurance fraud may come in many different forms, including an injured employee who intentionally misrepresents information or hides the truth with the intent to receive money or other benefits from an insurance company.

Even if you suspect fraud, you must still report the injury to SFM. Your SFM claims representative will investigate the claim and determine whether the evidence falls under the state's legal definition of fraud.

A segment for claims coordinators on 'incident-only' claims. Taken from SFM’s "Responding to work injuries" webinar. For specific information about your state's laws, click on the appropriate state icon to the left.

It's just a minor injury

All injuries should be reported to SFM, even minor ones. By reporting an incident, you are preserving the necessary information you will need if the injury later requires medical attention or lost time from work.

SFM does not set aside reserves for any incidents that don't require medical treatment or lost time from work, so the claim is opened and closed the same day and will not affect your premium.

See what other situations to watch for when an employee is missing work in each state...

Other best practices to keep in mind:

• Report quickly to avoid state penalties.
• Notify SFM first, then your agent.
• Don't have the injured employee fill out the First Report.
• Complete the First Report as accurately and completely as possible.
• Assign a back-up claims coordinator if you're out of the office.
• Be sure you're reporting claims to your current workers' compensation insurance carrier.

View full detail on avoiding reporting mistakes (PDF) 

Related SFM resources Avoid these reporting mistakes CompTalk (Minnesota) State laws and penalties CompTalk (Minnesota) Incident-only reporting CompTalk Claims coordinator duties CompTalk These resources, plus more on other topics, are available in SFM's Resource Catalog.