| Processing Your Claim
Following are steps for processing your claim:
- Your agency will forward the completed Accident or Illness Report (Form ADM 4303) to your Managed Care Organization.
- Your health care provider will forward all medical information to
your MCO. You may be contacted by your
MCO to gather information regarding
your claim.
- Your MCO will provide your agency
with information regarding your work-related medical condition.
- Your agency will
review all the information received from your provider and MCO,
and then make a recommendation (certify or reject) on your claim.
- DAS's third
party administrator (TPA) will be informed of all information and
keep records regarding your claim. Your agency will make a recommendation (certified or rejected) on your claim before
it goes to the Bureau of Workers' Compensation for a formal decision (allowed or denied). The TPA
will then file your claim with the Bureau
of Workers' Compensation.
Notification from BWC
BWC will make a formal decision (allow
or disallow) on your claim.
BWC will send you a letter informing you
of your claim number. This is very important information. You should use
this number to refer to your claim when contacting your agency, your health
care provider, DAS, BWC or your MCO.
Soon after you receive your claim number, you will receive notification
of the approval or denial of your claim from BWC,
which makes the initial decision on your claim, and can overrule any recommendation
made by your agency. |
