Obtain whatever emergency treatment is required immediately. If the injury is not an emergency, the employee and his/her supervisor should call OptaComp together to report the injury. OptaComp is the State’s medical case manager. OptaComp will instruct the employee where to go for treatment. If the employee is not available, the supervisor should report the claim. OptaComp’s phone number is (800) 545-6565.
You should indicate when reporting the claim to OptaComp that you do not agree with the employee’s version of the accident and then notify your Division of Risk Management adjuster of the details. This may be done by telephone or email.
You should instruct your injured employee that they are to keep you advised of their work status following every medical appointment. Your agency should make every effort to accommodate work restrictions when needed and return the employee to work as soon as possible. You should communicate to the Division of Risk Management (DRM) adjuster immediately when an employee is taken off of work by the authorized physician, when their disability exceeds 40 hours, if you cannot accommodate work restrictions and when the employee has returned to work following being out of work. Finally, you should report any information which could impact the workers’ compensation claim to your DRM adjuster.
Wage statements will need to be completed on any file in which the employee’s disability exceeds one week or 40 hours. The adjuster will need the wage statement within a day or two of this event occurring. A wage statement is also needed on cases where no indemnity benefits have previously been paid but the employee is placed at maximum medical improvement with an impairment rating.
You should notify your adjuster at the Division of Risk Management. Please provide specific details as to why you feel fraud may be occurring.