Viewing and Reporting Claims
How to Report a Claim
If an employee reports an injury or illness, the employer must:
- Instruct the employee to immediately contact Company Nurse by calling (888) 770-0929
- Within 24 hours of knowledge of injury, provide the injured or ill employee with:
- DWC-1 Claim Form
- MPN Informational Pamphlet
- Pharmacy First Fill Flyer
- Receipt of Workers’ Compensation Information Form. Once the employee returns the DWC-1 Claim Form, the employer must complete the employer section at the bottom of the form and return a copy to the claims administrator.
- Complete the Employer’s Report of Occupational Injury or Illness (Form 5020) and return a copy to your designated claims administrator.