Claims ServicesWC Claims FAQ's
What qualifies as a first aid claim?
What is your reserving philosophy?
What is the experience level of your Claims Examiners?
Do you have any bilingual Claims Examiners?
How do you handle fraudulent claims and do you utilize subrosa?
How often can status be requested on claims?
Who will provide loss runs and in what format can we receive them?
Can we access your claim notes?
Who does ICW Group use for bill review?
Who do I contact for more information?
What qualifies as a first aid claim?
A claim is classified as a first aid claim if the employee requires one-time treatment and/or a follow up visit for the purpose of observation of scratches, cuts, burns, splinters or other minor industrial injuries, which ordinarily would not require medical care.
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What is your reserving philosophy?
Our examiners set reserves to reflect our best estimate of the most likely cost of the claim based on the information available and our years of experience. New claims are generally reserved within five (5) days from our receipt of the claim.
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What is the experience level of your Claims Examiners?
While the years of experience vary, our Claims Examiners are certified or in the process of being certified pursuant to California Insurance Code Section 11761. In addition, we provide extensive training to each examiner.
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Do you have any bilingual Claims Examiners?
Yes. ICW Group proudly employs many bilingual Claims Examiners and Assistants. We have Experts fluent in Spanish, Vietnamese and Tagalog. We also partner with outside translation services as needed.
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How do you handle fraudulent claims and do you utilize subrosa?
We have experts in our Special Investigation Unit (SIU) who work closely with our Claims Examiners on investigating possible fraudulent claims. Subrosa is utilized when we have adequate information to secure quality surveillance.
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How often can status be requested on claims?
You can contact our claims experts at any time to discuss the status of the claims. You can also request to receive formal status reports quarterly through your Broker/Agent or our Claims Supervisors.
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Who will provide loss runs and in what format can we receive them?
Experts in our Underwriting department will provide you with loss runs via fax or mail. See Contact Us to send us the request.
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Can we access your claim notes?
Because of privacy statutes, outside sources do not have access to our claim notes. We encourage open communication with our Clients and are always available to discuss claims.
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Who does ICW Group use for bill review?
ICW Group utilizes Stratacare/CareSolutions Bill Review services for medical bill review and PPO access.
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Who do I contact for more information?
Contact your Agent/Broker directly or our Claims Department at Contact Us.
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