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Florida Workers Compensation Managed Care Arrangement WHAT TO DO WHEN AN EMPLOYEE REPORTS AN INJURY When emergency medical attention is required, send the injured employee to the nearest medical facility and contact the telephone reporting center at 1-800832-7839 to report the claim. When an employee reports an injury not requiring emergency treatment, the following steps should be observed: 1. GATHER INFORMATION REGARDING THE INJURY Ask the injured employee how, when and where the injury occurred, and if there were any witnesses. 2. CONTACT TELEPHONE REPORTING CENTER AT 1-800-832-7839 TO REPORT THE CLAIM Upon direction from the Claim Adjuster, send the injured employee for medical treatment. Remember: If this is a medical emergency, direct the employee to seek medical attention immediately and then follow-up with this call. 3. DIRECT THE INJURED EMPLOYEE TO CHOOSE A PRIMARY CARE PHYSICIAN. In non-emergency situations, if the employee appears to need medical attention, either direct the employee to the Network Primary Care Physician (“PCP”) of your choice, or instruct the employee to choose a PCP from your list of providers within the Coventry Integrated Network (“Network”). All medical care must be provided through the authorized Primary Care Physician in order to ensure workers Compensation benefits. (A Medical Care Coordinator will be assigned by the Claim Adjuster after the employee’s injury has been diagnosed.) 4. COMPLETE AN EMPLOYEE INTRODUCTION LETTER Fill in a copy of the Request For Medical Treatment Form with the appropriate information. Give the completed Request for Medical Treatment Form to the injured employee and advise him/her to give the letter to the provider he/she has chosen as his/her PCP before treatment is initiated. 5. ARRANGE FOR THE EMPLOYEE TO BE TREATED BY A PROVIDER WITHIN THE NETWORK Either you, the Medical Case Manager or the Claim Adjuster should contact the PCP to confirm authorization of an appointment for treatment of the injured employee. 6. FOLLOW-UP AND RETURN-TO-WORK Obtain the DWC25 form (completed by the physician) from either the injured employee or the physician’s office. Work with the assigned Claim Adjuster/Medical Case Manager and the PCP to return the employee to either light or full duty. Evaluate any restrictions and offer modified duty if applicable. Rev. 2/2010