AMTRUST/ANTHEM PREMIER PLUS CLAIM REPORTING GUIDELINES
Within 24 hours of knowledge of an injury, the employer must provide the injured worker with the Employee’s Claim for Workers’ Compensation Benefits (DWC-1). The injured worker should complete the top portion of the DWC 1 and return it to the employer who will then complete the bottom portion of the form and give the injured worker a copy.
The employer also must complete the Employer’s Report of Occupational Illness or Injury (5020 Form).
The DWC-1 and 5020 Form can be downloaded by clicking on the appropriate link on the right of this page.
Risico prefers the DWC-1 and 5020 Form be sent at the same time, however, the employer should not wait on receiving the DWC-1 back from the employee prior to sending the 5020 Form. Both documents can be faxed at any time to Risico at 1-678-258-8587 or emailed to firstname.lastname@example.org. Claims can also be reported by telephone to Risico at 1-800-500-3744, Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m., PST.
Please be sure to keep a copy of both the DWC-1 and 5020 documents for your records.
California law requires that employers report within 5 days of knowledge of a claim for an occupational injury or illness that results in lost time from work or requires medical treatment beyond first aid.
Failure to report claims timely can jeopardize Risico’s ability to promptly investigate an injury, and can lead to unnecessary and excessive medical and disability costs, state penalties and fines, and a higher likelihood of litigation. The employers’ cooperation in prompt reporting is a key factor in managing workers’ compensation claim expenses.
For Amtrust/Anthem Premier Plus Claims:
Any person who makes or causes to be made any false or fraudulent material statement or material representation for the purpose of obtaining or denying Workers’ Compensation benefits or payments is guilty of a felony.