When an injury occurs, who does what and when?file_folder

  • Employers are responsible for:
    • Helping the injured worker obtain medical services
    • Establishing a reporting procedure for employees to follow
    • Assisting the injured workers in completing in-house accident/incident report
    • Certifying or rejecting the claim
    • ŸStaying in touch with the injured worker
  • BWC is responsible for:
    • Assignment of claim numbers
    • ŸDeterminations of allowed conditions
    • ŸPaying compensation
    • Identification of fraud
    • ŸEducation of injured workers, employers, and health care providers about HPP
  • Occupational Healthcare Providers are responsible for:
    • Providing timely and appropriate treatment for the injured worker
    • Follow up care and communication with the MCO and employer regarding medical and work status
    • Offering health management services programs for companies
    • Providing Physician Report of Work Ability
  • MCO’s are responsible for:
    • Medical management
    • Utilization review
    • Paying health-care providers for their services
    • Education of injured workers, employers, and health-care providers about HPP
    • Answering questions regarding medical bills
    • Answering questions regarding medical treatment
    • All claims and medical bills should be directed to the MCO representing the injured worker’s employer.  The MCO will handle the reimbursement for these services.
  • Injured Workers are responsible for:
    • Reporting on-the-job accidents to their employers promptly
    • Completing all claim-related paperwork promptly and thoroughly
    • Keeping the employer and MCO informed of recovery progress
  • TPA’s are responsible for:
    • Hearing representation—TPA’s are a party to the claim and available to attend hearings to represent employer
    • Claims administration—assistance in determining compensation and ensuring timely resolution
    • Actuarial Analysis
    • Group Rating Programs