Claim Reporting Guidelines
Always follow these guidelines when an employee sustains a work-related injury or occupational disease.
- Report all work-related injuries or occupational diseases, regardless of severity and regardless of whether the injury/illness can be verified.
- Report all claims immediately. You may be subject to penalties and fines for failing to report and/or late reporting.
- Prompt reporting can also save you money. Find out more.
How to Report a Claim:
- Fill out a "First Report of Injury" form for each claim. Keep an extra copy of the report
to satisfy Occupational Safety and Health Act (Federal Form 101) requirements.
Click here if you need a "First Report of Injury".
- Report all lost time, questionable or occupational disease claims immediately to the
Claims Department by calling our TOLL FREE NUMBER 1.800.825.9489 or fax to 1.800.832.8793
- If reporting by phone: Please have your policy number and the name of insured/policyholder as it appears on the
policy. In addition, please have the following Claimant information:
- Full name, age/d.o.b., & social security number
- Date of employment, hours of employment, &wages
- Date, time, and location of injury
- Home address and phone number
Submit all medical bills or reports that you receive to us by fax at 1.800.832. 8793 or
mail to: P.O. Box 219497, Kansas City, MO 64121-9497. Please include your policy
number and/or claim number on all communications following the First Report of Injury.
If you have a deductible on your policy: Regardless
of your deductible, you must still meet the requirements
and obligations of state statutes and your insurance
policy.
- We will process, pay and file all required documents as needed, regardless of the deductible amount
- We will send you a written request for reimbursement
If you have questions, please call the Claims Department directly at 1.800.825.9489
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