By Donna Motley, Vice President of Claims

HOW TO FILE A CLAIM – Sounds simple, right? There is more involved than one might anticipate.

Claims can be filed with our department via facsimile, e-mail or MTMIC’s Portal. (No one uses U.S. mail anymore – if for no other reason, it takes too long!) Early reporting is best. The longer the delay between the date of injury and the date received in our office results in additional investigation of the circumstances surrounding the incident. Causal relationship has to be identified. When claims are reported within one or two days of occurrence, most, if not all, details are still fresh in everyone’s mind. Similar to the childhood game of “re-telling” a story, the more time that passes, the more likely the story (or in this case, facts) can change. Studies have been done where five people witness the same motor vehicle accident, and there are five different versions as to “how” the accident occurred. Wait an additional five days and details tend to blur, change or be forgotten.

For these reasons, following a work related injury at your facility, you should obtain a written statement from the injured worker (either the day of the incident, or the day following the incident), the Supervisor’s report and/or investigation of the incident and statements from witnesses. The more information that can be provided to our department, the faster we can make a determination of benefits, assign a Nurse Case Manager if necessary, schedule the injured worker to see an appropriate physician and approve or authorize appropriate and necessary treatment.

After an initial visit with a medical facility, a copy of all paperwork should be forwarded to our attention. Per the Michigan Workers’ Compensation Act, Workers’ Compensation exclusively controls medical treatment for the first 28 days. Should an injured worker seek treatment with their primary care physician, payment for said visit will not be covered by Workers’ Compensation and the physician’s instructions or orders will not be honored. Typically, hospitals and Urgent Care facilities will refer an injured worker to their primary care physician for follow-up treatment. Again, following treatment at a hospital or Urgent Care facility, if filed immediately, the quicker we can direct medical care.

The accuracy when completing the Form 100, the Employer’s Basic Report of Injury can be crucial when submitting the claim. Particularly when submitting the claim through MTMIC’s Portal. We are in the process of converting to a new Claims System that will connect to the Portal. The information submitted through the Portal will automatically “up-load” to the Claims System, and, if all pertinent information is completed on the Form 100, a Claim Number will be automatically established with an instant response to the insured after the claim is reviewed by our office. IF the Form 100 is missing information, such as Date of Injury, Social Security Number, Date of Birth, Employee Address, Date of Hire, Occupation, Date Employer was Notified or Description of Injury, including body part injured, the claim cannot be set up until the missing information is gathered. (Computers – gotta love them!)

Also of importance is the name and location of the treating facility/facilities. With that information we can immediately request medical records and make a determination regarding additional treatment. We must be able to verify the injury through medical records.

In emergency cases, you can always call our office first and we will walk you through the process and aid in what needs to be done. The bottom line is for the employee to fully recover from their injury and save the insured money!