Claims Processing: Incident Reports.

Please review the following Workers Compensation procedures. To ensure efficient responses to your needs, please follow all guidelines in a complete,accurate and timely manner. Please fax all completed forms to our office at (718) 686-0880.

  1. INCIDENTS REPORTS
    • Incident Reports must be faxed within 24 hours of the incident.
    • Do not wait to send the report with Friday's claim report.
    • Fill out forms completely and accurately and print them.
    • Administrators must sign Incident Reports before sending them to Risk Management.
    • All unsigned forms will be returned and must be resubmitted.
  2. MEDICAL INFORMATION AUTHORIZATION FORM
    • If an injured employee requires medical attention, he or she must see a facility physician.
    • Prescribed physical therapy must be provided in the facility.
    • For authorization of all outside referrals, contact Laya Haut.
    • Facility physicians are not permitted to refer to outside providers.
    • Each employee must sign a Medical Information Authorization Form.
  3. ATTENDING PHYSICIAN FORM
    • For each medical visit, the Attending Physician Form must be completed.
    • Fax the form to Risk Management along with doctor's notes and referrals.
  4. WORKER'S COMPENSATION SUMMARY REPORTS
    Fax Workers' Compensation Summary Reports every Friday before 1:00 PM.
    1. New Incidents:
      Include employees that have been injured during the current week. An Incident Form must be submitted for all new claims. The next report should list new names as "returned to work" or "on going out of work."
    2. ON Going - Out Of Work:
      List employees presently out of work, noting the last day worked (or injury date). Each name should remain on the list until the employee returns to work or is discharged.
    3. Returned to Work:
      List employees who have returned to work during the current week. It is not necessary to include these names with the next report.
  5. WAGE STATEMENT
    • If an employee misses seven or more consecutive work days, a Wage Statement must be completed.
    • Fax the completed form to Laya Haut at (718) 686-0880.
    • Wages can then be paid promptly.
  6. When all medical bills for an employee have been received, please mail forms to:

    Risk Management
    4722 18th Avenue.
    Brooklyn, NY 11204

    DO NOT FAX BILLS OR CORRESPONDENCE.
    Mail all forms to the above address. If you need further assistance, please call Laya Haut, W. C. Coordinator, Risk Management at 718-686-7272, ext. 15.