This New Kit Is Your All-In-One Claims Reporting Resource
At State Fund we have redesigned and updated our Claims Reporting Kit to be a central reference source for our customers on how, when, and where to report a claim as quickly and efficiently as possible. All current policyholders will receive the new Kit in the mail by November 21, 2005.
Should you need additional copies, you can order them through the State Fund Customer Service Center at (888) 222-3211. An electronic version of the Kit will be available on our Web site. Additionally, policyholders and brokers with user access can order copies of the Kit through State Fund Online.
This compact, yet comprehensive, Kit contains all the forms and information you need in one handy location to help you expedite your reporting. Remember, filing the Employers’ Report form does NOT constitute an admission of liability.
Features include:
- Step-by-Step Advice and Explanations:
- When an Occupational Injury or Illness Occurs…
- When Is the Treatment First Aid?
- What About More Extensive Treatment?
- Contact Numbers:
- Claims Reporting Center phone: (888) 222-3211 (where we handle the details for you anytime, day or night!)
- Claims Reporting Center fax: (800) 371-5905 (your alternative option for reporting; we will contact you for additional information as needed.)
- Mandatory Forms:
- Employer’s Report of Occupational Injury or Illness (form 3067)
- Workers’ Compensation Claim Form (form 3301/DWC 1)
- Mandatory Brochures and Posters:
- New Employee’s Guide to Workers’ Compensation (form 15765-English; form 15766-Spanish)
- Employee’s Guide to the State Fund Medical Provider Network (form 13142-English; form 13143-Spanish)
- Notice to Employees (Employer Posting Notice: form 13708-English; form 13709-Spanish)
- Customer Service Center Items:
- Claims Reporting Center Sticker (form 13828)
- Customer Service Center Magnet (form 13161)
- Customer Service Center File Card (included with form 13244)
As soon as you obtain the new Claims Reporting Kit (dated New 10/05), discard any previous versions you may have. Then you’ll be equipped for faster, easier claims reporting to benefit your injured employee and your business.
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