Reporting
Work Comp
Claims

Once you’ve initiated a workers’ compensation claim with us, you’ll be contacted by your Claims Examiner for additional details within 2 business days after we receive your claim. If you have a California or Illinois claim with lost time, an examiner from our specialized Triage Unit will be assigned to assist.

Learn more about the Claims Process in From First Report to Return to Work and our Specialized Claims Triage Team.

Your Claims Examiner will contact you within 2 business days after we receive your claim. At this time, they’ll provide you their name and contact information. Within one week of reporting your claim, you may find your Claims Examiner information online by reviewing your Loss Run Reports and Claim Summary Reports in myResource.

Workers’ compensation provides benefits to employees who get injured or sick from work-related causes. It includes reasonable and necessary medical treatment and related costs, and temporary/permanent disability benefits, missed wage replacement and survivor/dependent death benefits. This may include vocational rehabilitation benefits, depending on jurisdictional requirements.

Both loss runs and claims summary reports are available in ICW Group’s myResource system.

If you don’t yet have an account, apply for one today using Request a myResource Account. Please note, you must be provided permission by an Owner or Officer of your Company to access these reports.

By law, we’re required to set up a claim whenever one is reported – even if the person isn’t your employee. Rest assured our claims team will conduct a thorough review to determine the circumstance, possible coverage and liability.

Generally, the answer is no, but if you receive any legal paperwork listing you as the employer involving an injured employee from a temp agency, you should immediately report this to ICW Group so that we may set up a file and conduct an investigation.

When your employee is injured, first make sure they get the medical treatment they need. Call 911 for any emergency situation.

Based on the nature and severity of the injury, we suggest you decide if an urgent care clinic is appropriate. In some instances, the nearest urgent care option may be the emergency room. After providing your employee with medical treatment options and facility information, report the injury to ICW Group.

You can find step-by-step information and forms on our Report a Claim page.

As of 1/1/24, compensability presumptions under Senate Bill 1159 have been repealed which includes the COVID-19 outbreak calculation. Therefore, employers no longer need to report non-work related COVID-19 positive tests, however employers should consider maintaining consistent policies re keeping a copy of COVID-19 tests in their employees’ personnel files.

For all medical treatment related bills, send to ICW Group, P.O. Box 2965, Clinton, IA 52733-2965.

For other claim related bills or reimbursement requests, send to ICW Group, PO Box 509039 San Diego CA, 92150-9039. Or, you may fax these to 858.350.2755.

No. All work-related injuries with medical treatment must be reported to ICW Group. If you, or your employee receive a medical bill related to a work injury, please forward it to ICW Group for payment consideration.

For all medical treatment related bills, please send to ICW Group, P.O. Box 2965, Clinton, IA 52733-2965.

Workers’ compensation medical treatment rules vary by state. Some states allow the employer/insurer to direct care and others allow the employee to choose the physician. Your Claims Examiner can provide you additional information concerning your own state’s medical treatment guidelines.

If you need further assistance regarding your claim, please contact your examiner at 800.877.1111.

We encourage you to talk to your employee so they understand they’re required to work within the restrictions outlined by their treating physician. This will help them avoid re-injury or worsen their condition.

For further assistance on this situation, please contact your examiner at 800.877.1111.

Be sure to inform your Claims Examiner if you’re able to accommodate modified duty. They’ll convey this information to the doctor and inquire if the employee is able to perform work with modified restrictions. Your Claims Examiner can help walk you through this process to get the best possible outcome.

To understand more about Return to Work programs and what you can do, see The Road Back to Work: Building a Successful Return to Work Program.

If your employee declines the offer or does not show up for work, you’ll have written documentation of a good faith offer of work as well as documentation showing that the employee had knowledge of the offer. The workers’ compensation benefits owed to the injured employee may be impacted.

To help, we offer several references in our The Road Back to Work: Building a Successful Return to Work Program.

Making permanent accommodations for an injured employee’s work restrictions is considered an employment action. To help you with these types of Human Resource questions, ICW Group provides HR OnDemand^® – included free with your policy. Use this service to gain expert HR advice via phone, email or online.

For more information on this helpful service, visit our HR OnDemand page.

There’s no set length of time for a workers’ compensation claim. The duration depends on the complexity of the issues surrounding it, the resolution strategy and jurisdiction.

Some claims involve simple injuries that require minimal treatment, if any, and may be closed as soon as medical payments are issued. Others may be more complex and involve serious injuries with extensive medical treatment needs, vocational rehabilitation, subrogation, hearings, third-party actions, death, fraud, etc.

For most cases, a workers’ compensation claim is never really “closed” as there are various applicable statutes of limitations laws, depending on jurisdiction. For example, a case may reopen if the work injury or condition worsens. Some cases conclude when the injured worker accepts a full and final settlement offer designed to settle all remaining issues, and or current and future claim benefits.

You can quickly learn the status of the claim by referring to your online loss run reports, accessed through ICW Group’s myResource. If you have questions about accessing loss run reports, contact WC Loss Runs.

First, express your concerns with your Claims Examiner – they can help answer any questions. After you speak with your examiner, you can also call the ICW Group’s Fraud Unit, 800.877.1111. They’re experts in this area and are available to help answer any questions or concerns you may have regarding suspected fraud.

For helpful Fraud resources and tools, see the Fighting Fraud page. Be sure to download the R.E.P.O.R.T. Worksheet to help guide your Investigation and view the 10 Ways You Can Prevent Fraudulent Claims for additional advice.

Yes. EVERY claim processed is automatically reviewed for fraud within 24 hours and vetted using 3,000 data points. Also, all claims are automatically checked for signs of fraud multiple times throughout the life of the claim.

See The 8 Ways We’re Extra Tough on Fraud for additional information.

We can do this for you! Surveillance is a useful tool which is commonly used by ICW Group to investigate suspicious claims. While inhouse security systems are very helpful, we discourage customers from conducting outside surveillance or using private investigator firms, as there may be legal implications.

Red flags simply means there are suspicious actions that may necessitate further investigation. Suspected fraud occurs when we feel we’ve identified a deliberate, provable claim misrepresentation, which allows us to submit the claim to law enforcement for a criminal investigation. The final verdict of whether a claim is fraud is decided by the court.

See the Top Ten Red Flags of Work Comp Fraud for additional information.

The requirement to pay wage loss benefits and provide medical treatment varies depending on jurisdiction. In many jurisdictions, we’re required to continue benefits until clear and convincing evidence can be gathered to defend against the claim(s) being made. ICW Group partners with you in the investigation of questionable claims, gathering any available evidence which may assist in the proper defense of the claim.

For helpful Fraud resources and tools, see the Fighting Faud page.

Yes! In fact, staying connected with your employee after an injury shows compassion, fosters a trustful relationship and can help minimize claim costs.

To easily send thoughtful messages and provide helpful materials, see our “On the Road to Recovery” Ecards, available in both English and Spanish.

Yes! ICW Group offers HR OnDemand as a free service to all our current policyholders for assistance with employment related questions. You can call them between the hours of 8am to 7pm Central Time, Monday through Friday at 1-855-473-6782.

For more information on this helpful service, visit our HR OnDemand page.

Alternatively, you may want to contact an employment attorney.

ICW Group offers HR OnDemand as a free service to all our current policyholders for assistance with employment related questions. You can call them between the hours of 8am to 7pm Central Time, Monday through Friday at 1-855-473-6782.

For more information on this helpful service, visit our HR OnDemand page.

Alternatively, you may want to contact an employment attorney.

Yes! Simply access your Claim Summary Reports and Loss Reports using myResource. Please note, you must be provided permission by an Owner or Officer of your Company to access this confidential information.

Need a myResource Account? See Request a myResource Account.

Of course! Quickly access your Loss run and Claim Summary Reports using myResource. If you have questions about loss runs, contact the Service Center of Excellence. Please note, you must be provided permission by an Owner or Officer of your Company to access this confidential information.

Need a myResource Account? See Request a myResource Account.

As an employer, there are several steps you can take to help control the cost of a claim:

• Report the incident as soon as possible.
• Set aside any evidence such as machinery, equipment or other item(s) that may have been involved in the accident.
• Provide your Claims Examiner with all relevant information, including witness information, video if available, diagram(s) or photo(s) of accident site, incident reports, and details concerning any equipment/machinery that may have been involved.
• Provide any medical information you may have at the time of reporting the injury.
• Make every effort to accommodate medical work restriction(s).
• Maintain positive contact with your employee at regular intervals.