Workers’ Compensation was designed to assist you with the process of recovery from a work related injury.
As the insurance carrier for your employer, our partnership with you in this process is to provide proper benefits and see to it that you receive the most timely and appropriate medical care available, so you can return to your normal lifestyle with as minimal disruption as possible.
As an employee, your partnership role in your recovery process is equally important by keeping in constant communication and working together with us, your physician and employer.
The Claims Process
Upon receiving the report of industrial injury (WC-1) form from your employer, our claims professionals will contact your employer and medical provider and, in many cases, will be in contact with you to gather information about the incident, discuss the case status and provide benefit information.
As part of the information gathering process, we will be seeking your assistance to review, sign and return a Medical History and Authorization form in order to more quickly acquire your medical records so that we may expedite your benefits.
LOST TIME / RETURN TO WORK
In the event that you are losing time from work, you will need to provide us with disability certification from your attending physician. Without this certification, we are unable to determine whether you are even eligible for wage loss benefits. However, once we receive this, we will evaluate your eligibility for temporary disability benefit payments and work closely with you, your employer, and medical provider to transition you into an appropriate return to work setting as soon as it is medically indicated, so as to avoid any further disruption to your pre-injury lifestyle.
NURSE CASE MANAGEMENT
In some cases, you may also be contacted by our designated Telephonic or Field Nurse Case Manager. S/he is a Registered Nurse (RN) who will be at your disposal to answer any medical questions or concerns and will be seeking to insure that you receive the best possible medical care for your injury.
RX PROGRAM / MEDICATIONS
Crum & Forster has partnered with Helios (an Optum Company) to eliminate your need for out-of-pocket expenses and to simplify your prescriptions.
If you’ve been given a prescription from your medical provider, you may take it to any of the pharmacies in the Helios Tmesys (“Tem-eh-sis”) network. Most pharmacies, including Walgreens, CVS (Long Drugs) and all major chains, are included in the network. To find a network pharmacy, call 866-599-5424 or visit www.helioscomp.com and click on “Resources” and “Pharmacy Locator.”
At the initial visit to your pharmacy, advise the pharmacist that you are or will be in the Tmesys network and ask that they contact your claims adjuster or 808-537-5221 for authorization.
Shortly thereafter, you will be provided with a permanent pharmacy card for future prescription fills.
In the event that you require the same medications over an extended period, arrangements can be made for home delivery services. Please contact your claims adjuster for more information.
Should you need to contact Helios directly, you may reach them at 800-964-2531.
Most full-time and part-time employees who suffer from any injury or disease, which results from work or working conditions, are covered. Under the law, certain kinds of employees are not covered.
- Immediately report the injury to your immediate supervisor or employer. You can do this orally or in writing.
- Obtain appropriate medical treatment for the injury.
Upon notifying your employer of your work-related injury, they will file an “Employer’s Report of Industrial Injury/Illness” (WC-1) with us. If they have not filed this report, you may contact our Regional Claims Director, Cory Okamoto at 526-1619, for administrative intervention.
If you are injured as a result of your work, you should tell the person treating you that this is an industrial injury. Ask the physician to send the medical reports and bills to us at: Crum & Forster – WC Claims 733 Bishop Street, #2200 Honolulu HI 96813
You may obtain treatment from a physician of your choice. However, you may be under the care of only one (1) attending physician. Your attending physician may refer you to other specialist(s) with our prior approval.
You may change your attending physician once, but you must notify us before making the change. Any other changes in physician require our approval before making the change.
If your claim is accepted, workers’ compensation should pay for reasonable and necessary:
- Treatments for the injury
- Hospital charges
- Prescription drugs ordered by your doctor
- X-rays as prescribed
- Physical therapy as ordered by your doctor
If your physician certifies that you are unable to work because of an industrial injury, you may receive Temporary Total Disability (TTD) benefits, as wage replacement, after a three-day waiting period. You may receive 2/3 of your weekly wages up to a specified maximum.
The three-day waiting period begins on the first day of disability which is certified by your attending physician. There are no retro-active periods or thresholds for the waiting period; the first three days of certified disability are simply not payable.
The maximum weekly benefit is determined by the state and varies, in accordance with the year in which your industrial accident occurred.
If your workers’ compensation claim is disputed and you are not paid benefits, you may inquire with your employer about filling a temporary disability insurance (TDI) claim.
(*note: Crum & Forster does not handle TDI Insurance)
If you are eligible for TDI benefits, you will be paid benefits at rates allowed by the TDI law. If your workers’ compensation claim is later found to be compensable (accepted), the TDI carrier may recover the amount they paid from your workers’ compensation benefits.
If your workers’ compensation claim is disputed and you have sought medical treatment, your medical provider will normally continue to bill us directly for your treatments. We will hold the bills in our file until a final (acceptance/denial) determination is made. If the claim is accepted, we will notify you and process the bills for payment. If the claim is denied, you and your medical provider will be notified. Medical providers will usually then forward the billing to your private health care insurance carrier for payment.
After you reach the point of stability or maximum medical recovery, you may be sent to an independent physician to be evaluated, depending on your type of injury. The evaluation will be used to determine the extent of your permanent impairment. In some cases, PPD benefits may result from the evaluation.
If your injury results in noticeable permanent disfigurement, you may be entitled to a disfigurement award. Disfigurement includes scars, deformity, and discoloration. Laceration scars and surgical scars are resolved after six months from the date of the occurrence, while burn scars are resolved after one year.
If we are unable to reach an agreement on certain issues, you do have a few options. You may:
- Contact the Facilitator at the Department of Labor & Industrial Relations – Disability Compensation Division for feedback and direction.
- Request a Hearing with the Department of Labor & Industrial Relations – Disability Compensation Division by writing to them at the address on the island on which you reside.
To reach the DCD, address all inquiries to: Department of Labor and Industrial Relations Disability Compensation Division
P.O. Box 3769
Honolulu Hawaii 96812-3769
Phone: (808) 586-9161
East Hawaii (Hilo)
State Office Building:
75 Aupuni Street
Hilo, Hawaii 96720
Phone: (808) 974-6464
West Hawaii (Kona):
P.O. Box 49
Kealakekua, Hawaii 96750
Phone: (808) 322-4808
State Office Building, #2:
2264 Aupuni Street
Wailuku, Hawaii 96793
Phone: (808) 322-5322
State Office Building:
3060 Eiwa Street, Room 202
Lihue, Hawaii 96766
Phone: (808) 274-3351