Customized communication database

Connects the claims team with various client roles

Monitors events and situations specific to individual claims:

Early Claim Alert captures early intervention opportunities, notifying the right person, for the right solution, at the right time.

Easily activated:

Want to send a medical authorization to the clinic before the employee arrives? We can!

Client: want reminders to complete:

We can!

EARLY CLAIM ALERT: Medical Event Report

Complete the following to trigger the notification system.

Employee Name (Last, First, Middle): ,
Job Site
Date of Injury (MM/DD/YYYY)
Date Reported to Employer (MM/DD/YYYY)
Brief Description of Injury
Medical Treatment Type


This notification authorizes the initial medical treatment for a reported work-related injury.

Employee and Incident Data
Name: Adams Andy A.
Date of Injury: 5/2/2016     Date Reported to Employer: 5/2/2016
Injury Description:
Andy slipped on a puddle of water on the bathroom floor, fell, and hurt his arm.

Medical Provider: Westside Urgent Care Clinic
Address: 1122 N 33rd Street
         Anyville, OR 97000
Fax: (541) 555-1234     Email:

Please provide the employee with a copy of any treatment recommendation and their curent work status report prior to the employee leaving your facility.

This employer has an early return to work program and can accommodate most temporary work restrictions. Please detail the work restrictions in your work status report. We look forward to working with the physician and assisting our employee with a speedy recovery.

Employer Contact Information
Organization: Kleen Maintenance Co.
Address: 4321 Washingtion Ave.
         Anyville, OR 97000
Workers' Compensation Contact: John Smith
Phone: (541) 555-2345     Email:

Billing Contact Information
Insurer: Example Mutual Insurance
Address: 123 Commercial St.
         Anytown, CA 90000
Phone: (123) 555-9876     Email:

Billing Instructions:


Initial Medical Treatment

Submitted by: Briggs, Barbara B. <>
Claim: Adams, A     DOI: 05/02/2016
Account: Kleen Maintenance Co. > Main Office > Custodial

Provide an update on medical treatment and current work status for this event.

Go Now


  • Jones, Jenna <>

Account: Kleen Maintenance Co. > Main Office > Custodial
Claim: Adams, Andy A.
DOI: 05/02/2016
Reported: 05/02/2016 by Briggs, Barbara B. <>
Provider: Westside Urgent Care Clinic

Medical Treatment and Work Status Update

Medical provider (Westside Urgent Care Clinic) has been provided an authorization for treatment.

Employee was treated on: (MM/DD/YYYY)
Employee declined treatment

What was the result of employee's medical treatment? The physician's decision was:
Full Duty | Modified Duty | Off Work | Hospitalized

Effective date: (MM/DD/YYYY)

Do you want to send the Employee Medical Treatment Survey?
Yes: Employee's email:

Next medical appointment date (if known): (MM/DD/YYYY)

Date returned to work: (MM/DD/YYYY)

Situational Assessment: Are any of these conditions present? Check all that apply. (Each condition checked requests the indicated service.)

Known employment problem (e.g., excessive absenteeism, performance issues)

Employee concerns re: injury/medical treatment

Case management notified re: contact physician

RTW assistance to coordinate modified duty

Case management/RTW coordinator notified re: modified duty. Urgent Request.

Suspicious incident circumstances


Case Mgmt. Request - RTW

Submitted by: Jones, Jenna <>
Claim: Adams, A     DOI: 05/02/2016
Account: Kleen Maintenance Co. > Main Office > Custodial

Please contact me at your earliest opportunity to discuss RTW services.

Go Now


  • Donaldson, Denise <>
05/02/2016 Initial Medical Treatment [green] Completed
05/02/2016 Authorization of MedicalTreatment [green] Completed
05/03/2016 Modified Duty Notification [green] Completed
05/03/2016 Case Mgmt. Request - RTW [green] Completed
05/04/2016 Case Mgmt. Followup - RTW [green] Completed

A communication tool to bridge the gap on the day of injury

Customizable to every organization, claim & client


No hurdles technology-do you have internet? Use email?

Inexpensive, annual subscription

Optional tools:

More Info? Go to the Contact panel on our website.

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