Gallagher Bassett Services, Inc is the new Third-Party Administrator. Effective February 1, 2023, employees will call 1-833-891-1372 to report a worker’s compensation claim.
Note: If the incident requires NO medical action, please use the incident only procedure.
If the employee needs to seek medical treatment for their injury/illness or comes back later seeking medical treatment after filing an incident only, follow the steps below:
• The employee must contact the Worker’s Compensation Hotline at 1-833-891-1372 to officially file a claim. If the employee cannot make this call, the supervisor may place the call.
• While the employee is making the call, the supervisor needs to inform the Worker’s Compensation Coordinator (WCC) of an incident resulting in a claim.
If the employee’s injury or illness is NOT AN EMERGENCY, The WCC (if available) will call SBLHS Occupational health and make an appointment for the employee to be seen. This is the treatment provider that EIU prefers to use. Their staff is knowledgeable and skilled in workman’s compensation.
If the injury is after hours of 8a-5p, but the local walk-in clinic is open, (7a-7p as well as open on weekends) you may send the employee to the closest walk-in clinic for initial treatment. The WCC may need to schedule a followup appointment at SBLHS to establish return to work status. If the employee is requiring medical treatment immediately, and it cannot wait until the next business day for Occupational Health, you may send the employee to the emergency room. The emergency room is to be used only if necessary; a true emergency, life-threatening injuries.
If the WCC is not immediately available, the supervisor should call SBLHS Occupational health to schedule an appointment for the employee. That number is (217) 258-2178 and they are located at 1005 Health Center Drive Prairie Pavilion 1, Room #104 (In a building across from the Hospital, not in the actual hospital).
• The next step is to complete the appropriate worker’s compensation forms:
1. Employee Notice of Injury/Illness - this form is a “fillable” form online, which the supervisor and the employee can complete together electronically. Once printed, please remember the signatures at the bottom of the last page.
2. Authorization to Use or Disclose Information Form
3. Workers' Compensation Medical Report (Employee takes to Medical Provider).
▪ This form is extremely important, so that the medical provider understands that this is a work comp and not a personal insurance claim. Remind employee of this.
4.Witness (s) Completes (if applicable):
5. Supervisor Completes:
o Supervisor's Report of Injury/Illness
Return all completed forms to the Worker’s Compensation Coordinator via email at firstname.lastname@example.org .
After sending electronically, you may send originals via internal mail to HR. If the forms are incomplete or incorrectly filled out, the Worker’s Compensation Coordinator will return the forms along with a memorandum outlining what needs to be completed or corrected. Failure to complete the entire reporting process could delay the claim and payment of bills.
Claims are processed and sent to The Work Comp Insurance Carrier for review by a claims examiner, who will determine if the claim is compensable or non-compensable. Please note that this decision is NOT made at Eastern Illinois University by the Worker’s Compensation Coordinator.
If the employee sought medical attention for the injury/illness, all medical bills and associated bills should be sent to the The Work Comp Insurance Carrier for processing. Note that co-pays should NOT be paid for a work-related incident:
Gallagher Bassett Services, Inc.
PO Box 2831
Clinton, IA 52733-2831
Failure to inform the medical provider that the injury/illness is work-related will result in the employee, or his/her insurance plan, being billed directly for the services. Please contact the EIU Worker’s Compensation Coordinator at (217) 581-5825 with any questions.
EIU WC coordinator:
Old Main Room 2020
Fax: (217) 581-3614