Workers’ Compensation CLAIM KIT – Delaware

Who will handle your claims?
The New Jersey Regional Claim Office will handle your Delaware claims:

305 Madison Ave
P.O. Box 1973
Morristown, NJ 07962

Phone: (888) 890-1500
Diane Parrish, Regional Director

How to report Workers’ Compensation claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report via e-mail:                              [email protected]
To report via fax:                                    1-877-622-6218
To report claims via telephone:           1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms and pamphlets does the employer need to be aware of?

Employer’s First Report of Injury
If you report the claim via the Internet or by telephone, you do not need to fill out this form. If you report the claim via fax, complete this form, and fax it to Crum & Forster at the fax number provided above.

Delaware First Report 4-14

Employers are required by law to file a First Report of Occupational Injury or Disease within 10 days after knowledge of a work related injury to the Office of Workers’ Compensation and their workers’ compensation insurance carrier. A first report is required no matter how minor the injury. An employer may be fined $100 to $250 for failure to file a first report of injury. Note: the report is not an admission of liability and cannot be used as evidence in a contested claim.

Employer’s Modified Duty Availability Report
Within fourteen (14) days of receiving notice of Injury, The employer shall provide this form to the injured worker’s health care provider/physician and the insurance carrier.

Delaware Modified Duty Form

An employer may be fined $1000 to $5000 for failure to file the Employer’s Modified Duty Availability Report.

Statement of Wages
Average weekly wage is calculated by multiplying the employee’s hourly rate by the employers average work week. This information can be provided on the Employer’s First Report of Injury.

What is the Waiting Period for Lost Wages in Delaware?
The waiting period is 3 days. If the employee is off for more than 7 days, the first 3 days are paid retroactively.

What is the Choice of Physician Rules in Delaware?
Provider Selection
The employee chooses the treating provider without restriction.

Managed Care Options
Use of any managed care techniques must not interfere with the employees’ rights regarding choice of physician.

Preferred Provider Organization Network (PPO)
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:   www.talispoint.com/conduent/cfi

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites

Delaware Department of Labor / Division of Industrial Affairs / Office of Workers’ Compensation- http://dol.delaware.gov/

Multi-State Information- http://www.workerscompensation.com/