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Workers' Compensation FAQ

No, workers' compensation carriers are enjoined by most states not to solicit claims either from the group health benefits to workers' compensation or vise versa.

Physicians are the sole determinate of whether a claim is a workers' compensation claim or a group benefits claim. The attending physician examines the claimant. If it is industrial, that is the way it is filed. The status of the physician in the file is pertinent for the interpretation of their evidentiary opinion but note not all physicians can make the decision for the file.

On the job illness and / or injuries should be reported the moment they are know, by calling a Special Pacific Group Agencies, Inc. Claims 800-line.

The employer should still notify Pacific Group Agencies by the Special Pacific Group Agencies Claims 800-line, which is available 24 hours a day, 7 days a week, in order to activate the claim's Medical Case Manager. If this notification is not immediate, experience has shown, that the final claims cost is higher. The initial treatment's triage and medical direction is critical to an employer's realized claims savings.
Please send them at your convenience when the injury occurs.
Within 24 hours, Pacific Group Agencies will coordinate the claim set up and contact all parties with the claims information.
Pacific Group Agencies coordinates claims reserving which is usually lower, because our medical management is more effective in keeping the treatment within our contracted physicians network. By accomplishing this, the medical treatment outcomes are improved at lower costs.
Yes, and Pacific Group Agencies can coordinate the group's health plan medical data to match treatments, care plans and physicians to coordinate efficient medical care, regardless of cause.
The employer's proper notice entitles such a claims inspection, at the employer's convenience. Pacific Group Agencies coordinates claims on behalf of the employer, within the constraints of the law. In this capacity, the "Employer's Bill of Rights" is applied and a claims objection can hold up a claims settlement by writing to the court, who would then address it with the employer.
Pacific Group Agencies is very aggressive in protecting the employer's policy from criminal and careless access to workers' compensation benefits to the greatest extent possible. Methods center on the refer of all suspicious claims to Special Investigations and if they are found to be criminal, the District Attorney's office is notified.