Workers’ Compensation Claims

Optimizing
Claims
Outcomes

High-Quality Service and Communication

Crum & Forster’s claims professionals manage Workers’ Compensation claims through a blend of disciplined investigation and a state-of-the-art medical management program. Our customer service-based culture is embedded in everything we do. We take pride in contacting our insureds and initiating our investigation as soon as a claim is received. Our highly experienced claim professionals receive accolades from our customers on the quality of service we provide and the frequency of our communication.

Medical Bill Review

The cost of our medical bill review program is among the lowest in the industry, as most of the savings are incurred with nominal charges. Medical bills are reviewed for compliance with AMA and NCCI billing rules, causal relationship between injury and claim, and billed charges are processed for payment according to fee schedules or usual and customary charges. Discounts are available through our extensive network of preferred provider networks. Medical bills can be subject to nurse review, specialty review and negotiation.

Medical Networks

Medical networks are available in all jurisdictions with qualified providers who understand Workers’ Compensation and Crum & Forster’s return to work requirements. Employers have online access to our state-specific claim kits. The kits contain key Workers’ Compensation information to help facilitate claims processing. In those states where direction of medical care is permitted, we work closely with the injured worker in locating qualified treatment. Panel-posting notices and customized medical solutions are provided.

First Fill and Retail Pharmacy Card

Employers can issue a temporary pharmacy identification card to an employee at time of injury, which helps the injured worker avoid out-of-pocket expenses when he/she obtains medicine. Pharmacy benefit cards are provided to injured workers to secure prescriptions at our network of more than 62,000 providers. Our key national pharmacy network partners include Walgreens, CVS, Rite Aid and Wal-Mart.

Durable Medical Equipment and Mail Order Pharmacy

Durable medical equipment is provided to injured employees at contracted rates that reflect significant discounts. We offer a mail order pharmacy program with direct billing to Crum & Forster.

Telephonic and Field Case Management

Telephonic Case Management ensures that a trained medical professional can work closely with the injured employee, the employer, medical providers and the claims professional. A nurse case manager can assist with medical provider selection, arrange medical appointments and coordinate an injured worker’s return to work. Our Field Case Management service provides intensive in-person medical management of complex claims. Nursing professionals meet with the injured worker and agree on treatment plans with the medical providers that help the injured worker reach the highest level of functionality as quickly as possible.

Utilization Review

Utilization Review ensures that the proposed treatment plan is appropriate for the injury. In mandatory Utilization Review states, Crum & Forster has access to a processing system that scrutinizes each request according to state treatment guidelines. It can also review and approve routine care. Exceptional treatments are routed to nurse reviewers and medical specialists. The system is able to immediately facilitate the scheduling of approved diagnostic testing, durable medical equipment and physical therapy.

Diagnostic Testing

A specialized MRI/CT-Scan network made up of providers throughout the country is accessible through a toll-free number. We save, on average, 30% below fee schedule and usual and customary charges.

Catastrophic Case Management

Catastrophic injuries require highly specialized, extensive care and our Catastrophic Case Management program provides it at the top medical facilities in the country.