Workers compensation FAQs

Workers compensation is a state-mandated insurance program provided by your employer that covers medical treatment for your work-related injury or illness and lost wages if you are unable to work. The program also covers other services you may need during your recovery.

If you are unable to find your claims handleru2019s contact information, please call 1-800-362-0000 for assistance.

If you are unable to locate your claim number, please call 1-800-362-0000 for assistance.

Your claim check should arrive three to five business days after it is processed. Checks are sent via the United States Postal Service.

Your claim payment should appear in your account within three business days after it is processed.

Your claims handler can tell you the status of your payment. You may also be able to quickly access this information online through our secure website.

Your claim check/payment amount is determined based on a percentage of your lost wages, up to a specific dollar maximum, set by your state’s workers compensation statutory plan. Your claims handler will discuss the calculation in detail with you. If you have additional questions regarding state rules for calculating workers compensation benefits, please contact your claims handler or refer to your state’s workers compensation website.

In most states, workers compensation benefits are considered reportable but not taxable income. We encourage you to contact your tax advisor if you have additional questions. You may also find more information on your state’s workers compensation website.

The waiting period, or the length of time you must be disabled from work until you are eligible to receive workers compensation benefits, varies depending on the state and ranges from three to seven days. For additional information on the waiting period for your state, contact your claims handler or visit your state’s workers compensation website.

Treatment guidelines vary by state. In some states, employers can arrange to have injured workers receive treatment from physicians who specialize in work-related injuries. Before making an appointment, please contact your claims handler or nurse case manager to discuss whether you are able to receive treatment from your personal or primary care medical provider.

We can help you find a provider that is located close to you. To quickly find a local medical provider, use our online provider locator.

Please bring the following to your appointment:

• A list of your current medications
• Medical records related to your current injury, if available
• Work status report, if available

You should also provide your medical provider’s office with your claim number and the mailing address for your medical bills. Your claims handler can provide this information to you.

Yes. Please contact your claims handler or nurse case manager before changing your treating provider, as guidelines vary by state. You should also notify your claims handler or nurse case manager if your treating provider refers you to another provider or specialist.

Yes. Maintaining open and regular contact with your claims handler is an important part of the claims process. You should provide your claims handler with a status update after each provider visit. Your claims handler can help answer questions about your claim and will also work with you, your provider, and your employer to facilitate your recovery.

Your claims handler will promptly evaluate your workers compensation claim, explain your benefits, and arrange for medical treatment payments and any lost wage payments for which you are eligible. Your claims handler will also answer your payment questions and update your employer on your work and medical status.

If you are unable to work, be sure to:

• Communicate with your claims handler: Provide necessary information, including any required forms, to your claims handler so we can promptly process your claim. Let your claims handler know of any medical updates or changes to your work status.
• Follow your treatment and return-to-work plans: Attend your medical appointments and follow any work restrictions set by your doctor—doing so will help you avoid re-injury and facilitate your recovery. If you are unable to work, actively participate in return-to-work planning.
• Update your employer: Keep your employer updated on your recovery and work status. If you are unable to work, your employer may be able to provide an alternative work assignment until you can return to your regular job.

After promptly reporting your injury to Helmsman Management Services, your employer may contact you regularly while you are away from work, share information about your job’s physical demands with your doctor, and discuss possible temporary, short-term, or alternate job assignments with you and your claims handler if needed.

After evaluating your injury and providing appropriate medical treatment, your doctor should give you a plan for treatment and expected recovery. If you are unable to work, your doctor also helps develop a plan so that you can return to work. If necessary, he or she may recommend referrals to other medical professionals, such as physical therapists, etc. Your doctor will also monitor your recovery, address your physical capabilities, and share this information with your claims handler and employer. Your doctoru2019s evaluation may help identify temporary, alternative job assignments.

Helmsman Management Services may assign a registered nurse to your case to help answer your questions, ensure that you are getting the right treatment, and facilitate your safe return to work. Your nurse case manager may also review your jobu2019s physical demands and your work abilities with your employer, your doctor, and you. The nurse will also assist you and your claims handler by answering medical questions and updating your employer on your return-to-work and medical status as needed.

Yes. Explain your job functions in detail with your provider. When possible, your claims handler or nurse case manager will provide information about your job-related duties to your provider in advance of your appointment.

Yes. You should have ongoing discussions with your provider about your physical capabilities as they relate to your job. In some cases, your provider may identify work restrictions that could allow you to return to work in a modified job. Share any information you receive from your provider with your claims handler and your employer. Your claims handler will work with your employer to determine whether modified duty or alternative work opportunities are available.

Modified and light duties are transitional duties that enable you to work with restriction while continuing to recover from your work-related injury. Your provider may allow you to return to work with restrictions. Your claims handler or nurse case manager will work with your provider to determine whether you are able to return to work in a temporary modified or light duty job.

Yes. If your doctor prescribes medication for your workers compensation-related injury or illness and you fill the prescription at a participating pharmacy, the cost of your prescription is covered as part of your workers compensation benefit. Our pharmacy program, which is administered by our pharmacy benefits manager, Optum, is accepted at most major pharmacy chains, nearly 70,000 pharmacy locations. To find a participating pharmacy, please use Optum’s online pharmacy locator.

Yes. Optum offers a home delivery pharmacy program. If you qualify for home delivery, you may be contacted by Optum or your claims handler to discuss enrollment in the program. If you’d like to enroll in the home delivery program, please:

• Contact your claims handler
• Call Optum 888-328-0050

Benefits of the home delivery program include:

• Direct access to pharmacists: Registered pharmacists are available to answer your questions about medications as well as the home delivery process.
• Dedicated home delivery client specialists: Client services specialists are available to answer your questions about state-specific home delivery.
• A 90-day supply of your medication: You can order a long-term supply of your medication if prescribed by your doctor. This means fewer refill requests and trips to the pharmacy.
• No out-of-pocket expense: Similar to Optum’s retail pharmacy program, the cost of any medications prescribed for your workers compensation-related injury or illness are covered as part of your workers compensation benefit.

Please contact your claims handler or call Optum 888-328-0050. They will be able to assist the pharmacy in processing your prescription or help determine why the prescription cannot be processed.

To request a new pharmacy card, contact Optum 888-328-0050 and have your Helmsman Management Services claim number available.

Contact your claims handler if your medical provider prescribes durable medical equipment or other ancillary services for your workers compensation-related injury or illness.

Your provider should mail any medical bills for treatment of your workers compensation-related injury or illness directly to Helmsman Management Services. Your employer should provide this mailing address to you.

If you receive any medical bills, please call Helmsman Management Services at 1-800-362-0000 so we can provide you with the correct mailing address. Please share the mailing address with your provider so that they can submit the medical bill to us for review.

No. You are not responsible for any outstanding balance notices you receive for treatment related to your workers compensation injury or illness. If you receive an outstanding balance notice, please contact your claims handler. Your claims handler will work with your provider to make the appropriate payment based on your stateu2019s jurisdiction.

Please contact your claims handler immediately to discuss the situation and to address the collection notice.