Claim FAQs

For all medical treatment related bills, send to ICW Group, P.O. Box 2965, Clinton, IA 52733-2965.

For other claim related bills or reimbursement requests, send to ICW Group, PO Box 509039 San Diego CA, 92150-9039. Or, you may fax these to 858.350.2755.

No. All work-related injuries with medical treatment must be reported to ICW Group. If you, or your employee receive a medical bill related to a work injury, please forward it to ICW Group for payment consideration.

For all medical treatment related bills, please send to ICW Group, P.O. Box 2965, Clinton, IA 52733-2965.

This is a California State specific process, where an independent doctor is selected from a panel of 3 physicians (provided by the State), to help move the case towards resolution. A PQME may address compensability, nature and extent of the employee’s injuries and duration of their medical treatment. The PQME may also help determine the level of the employee’s permanent disability and their ability to return to work.

It depends on the jurisdiction of your claim. Some states do have specific laws concerning physician panels. That said, all states have their own rules regarding physician access options. Please contact your examiner at 800.877.1111.

It depends on a number of factors. Please contact your examiner to discuss your options. If you don’t have their direct number, simply call 800.877.1111.

Workers’ compensation medical treatment rules vary by state. Some states allow the employer/insurer to direct care and others allow the employee to choose the physician. Your Claims Examiner can provide you additional information concerning your own state’s medical treatment guidelines.

If you need further assistance regarding your claim, please contact your examiner at 800.877.1111.

Usually, there is nothing you need to do. The doctor’s office should have submitted this referral to your Claims Examiner. However, you may fax or email the referral to your Claims Examiner if you need further assistance.

We encourage you to talk to your employee so they understand they’re required to work within the restrictions outlined by their treating physician. This will help them avoid re-injury or worsen their condition.

For further assistance on this situation, please contact your examiner at 800.877.1111.

We encourage you to communicate with your Claims Examiners if you disagree with the direction of medical care. Each state may have its own rules regarding treatment disputes.

As an employer, you may be liable for treatment related to pre-existing conditions if the work injury aggravated, exacerbated or accelerated the condition.

Be sure to inform your Claims Examiner if you’re able to accommodate modified duty. They’ll convey this information to the doctor and inquire if the employee is able to perform work with modified restrictions. Your Claims Examiner can help walk you through this process to get the best possible outcome.

To understand more about Return to Work programs and what you can do, see The Road Back to Work: Building a Successful Return to Work Program.

For any injury resulting in lost time or permanent partial disability, regardless of whether your employee has returned to work, we may be required by law to obtain historical wage statements for up to 1 year from date of injury. This wage statement allows us to confirm your employee’s compensation rate and determine the regulated benefit rates for their jurisdiction.

As a general rule and depending on the claim jurisdiction, benefits are issued approximately 14 days from the first day of disability.

If your employee declines the offer or does not show up for work, you’ll have written documentation of a good faith offer of work as well as documentation showing that the employee had knowledge of the offer. The workers’ compensation benefits owed to the injured employee may be impacted.

To help, we offer several references in our The Road Back to Work: Building a Successful Return to Work Program.

It depends – there are a number of factors that determine whether a workers’ compensation claim is eligible for settlement. Since this could vary by jurisdiction, it’s best to contact your ICW Group Claims Examiner with questions regarding settlement.

Making permanent accommodations for an injured employee’s work restrictions is considered an employment action. To help you with these types of Human Resource questions, ICW Group provides HR OnDemand^® – included free with your policy. Use this service to gain expert HR advice via phone, email or online.

For more information on this helpful service, visit our HR OnDemand page.

By law, terminating an employee doesn’t end our responsibility to continue workers’ compensation benefits to which they are entitled.

Permanent Disability or Permanent Impairment is a statutory workers’ compensation benefit that employees are entitled to receive in many states. Benefits typically start at the time of maximum medical improvement or when the employee is released from their physician’s care. These benefits are owed to the employee even if they return to work in any capacity.

Often, a physician will not indicate an employee has achieved “maximum medical improvement” (MMI) until the employee has demonstrated their ability to perform full duty work for several days or weeks, depending on the nature of the work. Until then, we’re required to provide reasonable and necessary medical care.

Our top priority is to ensure your employee has reached the end of the healing period. We make every effort to settle or close every workers’ compensation claim as quickly as possible. If you have any questions or wish to discuss this further, please contact your Claims Examiner.

There’s no set length of time for a workers’ compensation claim. The duration depends on the complexity of the issues surrounding it, the resolution strategy and jurisdiction.

Some claims involve simple injuries that require minimal treatment, if any, and may be closed as soon as medical payments are issued. Others may be more complex and involve serious injuries with extensive medical treatment needs, vocational rehabilitation, subrogation, hearings, third-party actions, death, fraud, etc.

For most cases, a workers’ compensation claim is never really “closed” as there are various applicable statutes of limitations laws, depending on jurisdiction. For example, a case may reopen if the work injury or condition worsens. Some cases conclude when the injured worker accepts a full and final settlement offer designed to settle all remaining issues, and or current and future claim benefits.

You can quickly learn the status of the claim by referring to your online loss run reports, accessed through ICW Group’s myResource. If you have questions about accessing loss run reports, Loss-Runscontact WC Loss Runs.

First, express your concerns with your Claims Examiner – they can help answer any questions. After you speak with your examiner, you can also call the ICW Group’s Fraud Unit, 800.877.1111. They’re experts in this area and are available to help answer any questions or concerns you may have regarding suspected fraud.

For helpful Fraud resources and tools, see the Fighting Fraud page. Be sure to download the R.E.P.O.R.T. Worksheet to help guide your Investigation and view the 10 Ways You Can Prevent Fraudulent Claims for additional advice.

Yes. EVERY claim processed is automatically reviewed for fraud within 24 hours and vetted using 3,000 data points. Also, all claims are automatically checked for signs of fraud multiple times throughout the life of the claim.

See The 8 Ways We’re Extra Tough on Fraud for additional information.

We can do this for you! Surveillance is a useful tool which is commonly used by ICW Group to investigate suspicious claims. While inhouse security systems are very helpful, we discourage customers from conducting outside surveillance or using private investigator firms, as there may be legal implications.

By law, we must be able to demonstrate reasonable suspicion of fraud prior to conducting any surveillance. However, most claims are valid and therefore, surveillance is not appropriate nor legally allowed on every claim.

Red flags simply means there are suspicious actions that may necessitate further investigation. Suspected fraud occurs when we feel we’ve identified a deliberate, provable claim misrepresentation, which allows us to submit the claim to law enforcement for a criminal investigation. The final verdict of whether a claim is fraud is decided by the court.

See the Top Ten Red Flags of Work Comp Fraud for additional information.

The requirement to pay wage loss benefits and provide medical treatment varies depending on jurisdiction. In many jurisdictions, we’re required to continue benefits until clear and convincing evidence can be gathered to defend against the claim(s) being made. ICW Group partners with you in the investigation of questionable claims, gathering any available evidence which may assist in the proper defense of the claim.

For helpful Fraud resources and tools, see the Fighting Fraud page.

Your Claims Examiner will be happy to assist with answering all of your employee’s questions. Simply contact us – we’re happy to help!

Yes! In fact, staying connected with your employee after an injury shows compassion, fosters a trustful relationship and can help minimize claim costs.

To easily send thoughtful messages and provide helpful materials, see our “On the Road to Recovery” Ecards, available in both English and Spanish.

Of course, injured workers on workers’ compensation have all their related medical treatments covered. However, your employee’s health insurance is separate from workers’ compensation and are not covered as part of the benefits. Thus, these premium payments still need to be made to continue that coverage. How this is handled is an employment decision. To help you with these types of Human Resource questions, ICW Group provides HR OnDemand^® – included free with your policy. Use this service to gain expert HR advice via phone, email or online.

For more information on this helpful service, visit our HR OnDemand page.

Depending on the claim jurisdiction, an employee who accrues sick leave and vacation may be permitted to use the accrued time to supplement temporary disability payments. Please contact your examiner to learn more.

Yes! ICW Group offers HR OnDemand as a free service to all our current policyholders for assistance with employment related questions. You can call them between the hours of 8am to 7pm Central Time, Monday through Friday at 1-855-473-6782.

For more information on this helpful service, visit our HR OnDemand page.

Alternatively, you may want to contact an employment attorney.

ICW Group offers HR OnDemand as a free service to all our current policyholders for assistance with employment related questions. You can call them between the hours of 8am to 7pm Central Time, Monday through Friday at 1-855-473-6782.

For more information on this helpful service, visit our HR OnDemand page.

Alternatively, you may want to contact an employment attorney.

Yes! Simply access your Claim Summary Reports and Loss Reports using myResource. Please note, you must be provided permission by an Owner or Officer of your Company to access this confidential information.

Need a myResource Account? See Request a myResource Account.

Of course! Quickly access your Loss run and Claim Summary Reports using myResource. If you have questions about loss runs, Loss-Runscontact the Service Center of Excellence. Please note, you must be provided permission by an Owner or Officer of your Company to access this confidential information.

Need a myResource Account? See Request a myResource Account.

Yes! Since this involves policy coordination, please contact your Agent/Broker so they may work with the assigned Underwriter in making this possible for you.

As of 1/1/24, compensability presumptions under Senate Bill 1159 have been repealed which includes the COVID-19 outbreak calculation. Therefore, employers no longer need to report non-work related COVID-19 positive tests. However, employers should consider maintaining consistent policies with regards to keeping a copy of COVID-19 tests in their employees’ personnel files.

It depends. There are a number of different factors that influence how a claim is reserved. Your Claims Examiner can assist you with understanding the details of the reserve.

As an employer, there are several steps you can take to help control the cost of a claim:

• Report the incident as soon as possible.
• Set aside any evidence such as machinery, equipment or other item(s) that may have been involved in the accident.
• Provide your Claims Examiner with all relevant information, including witness information, video if available, diagram(s) or photo(s) of accident site, incident reports, and details concerning any equipment/machinery that may have been involved.
• Provide any medical information you may have at the time of reporting the injury.
• Make every effort to accommodate medical work restriction(s).
• Maintain positive contact with your employee at regular intervals.

It depends. There are a number of different factors that influence how a claim is reserved. It’s best to reach out to your Claims Examiner to discuss the timing of reserve changes.

You can quickly learn the status of reserves by referring to your online loss run reports, accessed through ICW Group’s myResource. You may also attain a loss run by Loss-Runscontacting WC Loss Runs and requesting this report. You must be an owner, principle or authorized user to receive a copy of the loss run.

Your insurance agency would be the best resource to assist you with questions about your rates and the calculation of your experience modification.