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Helpful tips

Claims Process in a Nutshell

If you are injured at work, we’re here to help. Here are some helpful tips to get you through your claim as smoothly as possible.

  • Immediately report your injury to your manager.

    • Write down the details of your injury (who, what, where, when, how). [for example: Tuesday afternoon, you were carrying a box in the warehouse and slipped, falling forward on your hands and knees. Now your right wrist is painful and swollen.]
    • Find out what paperwork is required by your employer to stay off and/or return to work [for example: a work note – ask your employer what they need specifically.]
    • Also ask if your employer has specialty forms that need to be filled out [for example: a functional capacity form, etc.]
    • Your employer has 7 days to report your injury and submit a WC-1 form (report of injury filed with the State). After your WC-1 is submitted you will receive your claim number so be sure to get a copy.
    • Always know your date of injury and claim number.
OccMed Health & Wellness - Occupational Therapy Honolulu, Hawaii

Getting Treatment

What to Expect

Part 1 – Physical examination

When you get treated for your injury, your care provider will describe the mechanism of injury and do a physical examination.

They may order tests, x-rays, MRIs, medications, physical therapy and define medical necessity to create a treatment plan.

Part 3 – Treatment

At the beginning of your claim, expect to visit your primary care provider every 1 to 2 weeks. Based on your recovery this may be changed to less frequent visits. You should be evaluated every month for ongoing care and return to work status.  Physical therapy, testing and studies might be delayed be proactive and call your provider. Treatment plans have a projected start date and an expiration date. Know your expiration date because you might be responsible for the payment. You can quickly and easily get an extension from your healthcare provider.

Part 2 – Treatment Plan

(requires approval)


The treatment plan is created by work comp doctors, treating surgeons or specialists, physical therapists, or drug dispensing companies. It’s a prescription for care that can include, physical therapy, surgery, procedures, massage, referral, follow-up office visits. It also includes diagnosis, date of injury, claim number, patient identifier. This treatment plan is sent to the adjuster for approval or denial. Expect 2-3 weeks for a response, but delays are common. Denials are typically due to no documented medical necessity or because the treatment isn’t the standard of care. Denials can be appealed.

Part 4 – Closing your claim

When you close your claim it is because you are returning to work or you have a total or partial disability.

When your provider determines you are at MMI/ Medically stable you either return to work without restrictions, return to work with permanent restrictions, or start in a vocational rehab, you can also resign from your position once your treatment is complete.

If your claim is closing due to disability you may receive an Independent Medical Exam (IME).  An IME is done by a specially trained physician and determines your level of disability.

Getting Treatment

What to Expect

Part 1 – Physical examination

When you get treated for your injury, your care provider will describe the mechanism of injury and do a physical examination.

They may order tests, x-rays, MRIs, medications, physical therapy and define medical necessity to create a treatment plan.

Part 2 – Treatment Plan

(requires approval)


The treatment plan is created by work comp doctors, treating surgeons or specialists, physical therapists, or drug dispensing companies. It’s a prescription for care that can include, physical therapy, surgery, procedures, massage, referral, follow-up office visits. It also includes diagnosis, date of injury, claim number, patient identifier. This treatment plan is sent to the adjuster for approval or denial. Expect 2-3 weeks for a response, but delays are common. Denials are typically due to no documented medical necessity or because the treatment isn’t the standard of care. Denials can be appealed.

Part 3 – Treatment

At the beginning of your claim, expect to visit your primary care provider every 1 to 2 weeks. Based on your recovery this may be changed to less frequent visits. You should be evaluated every month for ongoing care and return to work status.  Physical therapy, testing and studies might be delayed be proactive and call your provider. Treatment plans have a projected start date and an expiration date. Know your expiration date because you might be responsible for the payment. You can quickly and easily get an extension from your healthcare provider.

Part 4 – Closing your claim

When you close your claim it is because you are returning to work or you have a total or partial disability.

When your provider determines you are at MMI/ Medically stable you either return to work without restrictions, return to work with permanent restrictions, or start in a vocational rehab, you can also resign from your position once your treatment is complete.

If your claim is closing due to disability you may receive an Independent Medical Exam (IME).  An IME is done by a specially trained physician and determines your level of disability.