Claims Coordinator Responsibilities

The claims coordinator is responsible for receiving notices of injury from employees and serves as the liaison between an injured employee and SORM. The claims coordinator is responsible for submitting the required injury reports and notices to SORM and collecting statements from witnesses.

The Claims Coordinator Role as Liaison

When SORM receives notice that a state employee has been injured, a SORM adjuster immediately contacts the injured employee, the employee’s physician, and the employing agency. The claims coordinator is the primary point of contact between the adjuster and the agency. An adjuster will call the claims coordinator soon after receiving the injury report to verify that all the information on the report is correct. Early contact by the adjuster helps establish the facts of the on-the-job injury in complicated cases and aids in prompt medical treatment and payment of benefits that may be due. Early personal contact may also help to determine the possibility of third-party liability.

The adjuster will call the claims coordinator periodically to obtain additional information or to verify that the employee has returned to work. It is important that the claims coordinator immediately notify SORM when the employee has lost time or returns to work. Timely notification ensures that benefits are correctly paid to the employee.

An adjuster may ask for work schedules or other information about the employee’s injury that is available from the agency timekeeper or the employee’s supervisor. The claims coordinator is responsible for obtaining this information from their agency and providing it to SORM.

The Claims Coordinator Role in Claim Processing

The claims coordinator is responsible for supplying SORM with the appropriate information and forms so that SORM adjusters can properly process claims. There are various forms that the claims coordinator must file with SORM to ensure that the adjuster can manage the claim appropriately and remain in compliance with the law and DWC rules. There are very important time guidelines that must be adhered to when filing these forms. The forms and instructions for processing and submission are summarized in a checklist format. See the Forms and Checklists page.

Occupational Diseases

The employing agency is required to file a First Report of Injury with SORM for occupational diseases, even if the employee has lost no time from work.For occupational disease claims with a date of injury occurring on or after September 1, 1995, the injured employee’s eligibility for income benefits terminates 401 weeks after the date benefits are first accrued.

DWC provides the following classifications for occupational diseases/cumulative injuries through the Electronic Data Interchange (EDI) requirement.

  • Dust Disease NOC (All Other Pneumoconiosis)
  • Asbestosis
  • Black Lung
  • Byssinosis
  • Silicosis
  • Respiratory Disorders (Gases, Fumes, Chemicals, etc.)
  • Poisoning – Chemical
  • Poisoning – Metal
  • Dermatitis
  • Mental Disorder
  • Radiation
  • All Other Occupational Disease
  • Loss of Hearing
  • Contagious Disease
  • Cancer
  • AIDS
  • VDT-Related Disease
  • Mental Stress
  • Carpal Tunnel Syndrome
  • All Other Cumulative Injuries

Medical Only Claim

When the injured employee has a medical only claim and is not losing time from work, there are four critical forms that the claims coordinator must submit to SORM. However, SORM adjusters may request subsequent forms or additional information if needed.

The Employer’s First Report of Injury or Illness (DWC-1S) must be received by SORM not later than the 5th calendar day after the first notice of injury is reported to the employing agency. A copy of the DWC-1S is included in this handbook.

The claimant must complete the Employee’s Report of Injury (SORM-29) immediately after an injury occurs and the form must be received by SORM no later than the third calendar day of the filing of the first notice of injury. The form must be legible, and signed and dated by the claimant.

The Witness Statement (SORM-74) form must be completed for each witness to the injury or incident. The claims coordinator is responsible for collecting the completed forms and making sure that they are completed accurately. These forms must be received by SORM not later than the third calendar day after the first notice of injury is reported to the agency.

The claimant must complete the Authorization for Release of Information (SORM-16) immediately after sustaining a work-related injury. The claimant must sign and date the form. The form must be received by SORM not later than the third calendar day after the first notice of injury is filed.

Lost Time Claim

When an injured employee is losing time from work, there are additional forms that must be submitted to SORM. The Employer’s First Report of Injury or Illness (DWC-1S) must be received by SORM not later than the 5th calendar day after the first notice of injury is reported to the agency. A copy of the DWC-1S is included in this handbook.

The Employee’s Report of Injury (SORM-29) must be completed by the claimant immediately after an injury occurs and should be received by SORM not later than the 5th calendar day of the filing of the first notice of injury. The form must be legible and the claimant must sign and date the form.

Injured employees must choose whether they will utilize sick leave before receiving workers’ compensation income benefits on the Employee’s Election Regarding Utilization of Sick Leave (SORM-80). This form must be received by SORM not later than the 5th calendar day after the first day of lost time.

If the employee experiences one full day of lost time, not including the date of injury, the claims coordinator must submit the Employer’s Wage Statement (DWC-3) to SORM. This form should be received by SORM not later than the 5th calendar day after the first full day of lost time. If the employer suspends health insurance, the employer must file an amended DWC-3 with SORM within three days reporting the date of suspension.

The claims coordinator must complete a Witness Statement (SORM-74) for each witness to the injury or incident. The claims coordinator is responsible for collecting the completed forms and making sure that they are completed accurately. These forms must be received by SORM not later than the 5th calendar day after the first notice of injury is reported to the agency.

The claims coordinator must submit the Supplemental Report of Injury (DWC-6) to SORM for any of the following five different scenarios. Because this information is crucial to the timely stopping and starting of benefits, we request that the claims coordinator call the adjuster as soon as possible and follow up by faxing a DWC-6 to SORM.

1. When the employee returns to work, the form must be received by SORM not later than the third calendar day after the employee returns to work.

2. When an employee returns to work and experiences an additional day(s) of disability as a result of the injury, the form must be received by SORM not later than the third calendar day after employee loses the first additional day.

3. If the employee experiences a change in weekly earnings (increase or decrease) after the injury, the form must be received by SORM not later than the third calendar day after the end of the pay period in which this occurs.

4. If the employee resigns or is terminated, the form must be received by SORM not later than the third calendar day after that event.

The claims coordinator must submit the Notification of Additional Information (SORM-90) to SORM, not later than the next working day after any additional leave has been granted. We recommend that this form be faxed.

The claimant must complete the Authorization for Release of Information (SORM-16) form immediately after sustaining a work-related injury.

The claimant must sign and date the form. The form must be received by SORM not later than the 5th calendar day after the first notice of injury is filed with SORM.

Other Forms

If there is a change in an agency’s claims coordinator, the Change in Designation of Claims Coordinator (SORM-100) form must be received by SORM not later than 10 calendar days after the change.

The claimant must complete the Travel Reimbursement Form (DWC-48) when seeking reimbursement for travel expenses for medical care relating to work-related injuries. This covers authorized reimbursements for mileage, lodging, and meals. The claimant or claims coordinator must submit this form. It must be received by SORM not later than 30 calendar days after the date of travel.

Resources

See the Forms and Checklists page to download all of the forms listed above.