| Claims Process |
Catastrophic Injuries Claims Industry Links Investigation Forms |
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As professionals in a Maryland-based company, IWIF's claims adjusters
are experts in handling claims for Maryland employers. We are intimately
familiar with the workers' compensation community and the laws that
govern this jurisdiction. This expertise is invaluable to employees and
injured workers when injuries occur.IWIF's claims services include aggressive claims management. This process focuses on timely claims handling and quality medical care with a return-to-work objective for all injured workers. IWIF's comprehensive claims management services include the following Injury reporting Prompt injury reporting is the single, leading factor in controlling the cost and duration of a claim. IWIF makes injury reporting easy-- 24 hours a day/7 days a week. Preferred Provider Network When an employee is injured, prompt medical treatment is a top priority. Employers are often unsure about where to send their injured worker for medical care. With that in mind, IWIF has established a Preferred Provider Network. Through this program, quality medical providers are available in every region of the state. The preferred medical providers are recruited from all over Maryland to provide policyholders and their employees with access to quality medical care. Policyholders may locate and pre-select a medical provider before an injury occurs. To select a provider, call IWIF toll-free at 1-888-410-1400, or Locate Provider click here for IWIF's on-line Medical Provider Directory. Integrated Team Approach The IWIF claims adjuster and nurse case manager work closely together to ensure quality medical care and appropriate return to work for all injured workers. This team approach helps to facilitate necessary communication between the employer, injured worker, medical provider, and attorneys, if applicable. Timely and accurate compensability decisions are essential elements of effective claims handling. After an injury is reported, the claim will be referred to the claims department for assessment. The adjuster will determine if a claim is compensable, administer benefits, if warranted, and monitor activity on the file. A nurse is always available to assist the adjuster with medical questions, especially in complex cases. In addition, the Integrated Team Approach allows for timely involvement from Loss Control as well as from our in-house Legal Department and Special Investigations Unit. Together, all of these resources work to obtain successful outcomes for the injured worker and his or her employer. ExpressScripts (1-800-945-5951) This network of participating pharmacies in Maryland allows prescriptions to be filled with no out-of-pocket cost to the injured worker. ExpressScripts' telephone number is provided immediately upon confirmation of a newly reported claim. Note: The issuance of an ExpressScripts number is not a determination of compensability. Need a directory of participating pharmacies: Maryland Washington DC Delaware Pennsylvania Virginia West Virginia Pre-certification of Medical Services This component of IWIF's claims process allows pre-authorization of medical services to ensure quality care to injured workers as well as improved communication among providers, employers, and the injured worker. Pre-authorization of medical services also ensures prompt payment of medical bills. Independent Medical Examination (IME) The independent medical examination (IME) is a very useful tool in the claims handling process. The IME is a medical evaluation performed by an independent physician/specialist at the request of the employer/insurer. The IME is effectively used by the claims adjuster to evaluate the medical status or return-to-work status of the injured worker. Vocational Rehabilitation Services When an injured employee is unable to return to his or her pre-injury job due to a permanent disability, he or she may be eligible for vocational rehabilitation services. IWIF's team of claims professionals work with vocational specialists to achieve the goal of returning injured workers to gainful employment in the workforce. Subrogation Maryland Workers' Compensation laws are "no fault" in nature. However, Maryland employer/insurers have a statutory right to recover money spent on claims caused by a negligent third party. IWIF has established a dedicated Subrogation Department to investigate each claim with subrogation potential. When third-party liability is identified, IWIF's Subrogation Department will aggressively pursue negligent third parties to recover money that has been paid to claimants by IWIF. Recoveries by the Subrogation Department can be cash returns or credits against future claims payments. The Subrogation Department is responsible for recovering millions of dollars for our clients. |
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