Resources
Resources
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.
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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.
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- Get care at an emergency room, urgent care, or workman’s comp clinic.
- Before going to a clinic ask the staff if they accept workman’s comp insurance, Always have your date of injury and claim number.
- it is normal for private practices to request your primary insurance, even though they won’t be charging them.
- Make sure to give them any specialty forms that your employer or adjuster might have asked for.
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- When you are off work for a work comp injury, you must see your provider and have a work note. You are responsible for submitting your note to your employer so you can continue to receive benefits.
- Know which types of disability insurance you qualify for.
- Hawaii Temporary Total Disability (TTD)
- Hawaii Temporary Disability Insurance (TDI)
- Hawaii Family Medical Leave Act (FMLA)
- Federal FMLA
Learn more about each in the Different Types of Disability Insurance section lower on this page.
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Maximum Medical Improvement
After you have reached medical stability, you will be considered (MMI) Maximum Medical Improvement. This doesn’t mean you are 100% better or cured. It just means that you have reached the maximum improvement for this injury.
Work restrictions: You may or may not be given restrictions when returning to work. Work restrictions can include weight limits for lifting, limiting the time you stand, or limiting the hours you work. If you are still in treatment, and have returned to work, your workplace must provide accommodations recommended by your provider.
If your disability has changed your ability to return to the job you were doing you may be asked to do an FCE (Functional Capacity Exam).
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
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
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.
