Starting the process at BWC:  When you tell your doctor that you believe your injury is work-related, the doctor will report the injury to your MCO, which will in turn report it to BWC.  Also, as soon as you report your injury to your supervisor, your employer is supposed to report the injury to BWC (via the web, FAX, US mail, or the phone).  These communications officially notify BWC of your injury, and establish your claim for benefits.  Ask your doctor and your supervisor for a copy of their submissions for your records.

You will then get two letters from BWC. The first one confirms that BWC has received notice of your injury and set up a claim in your name.  NOTE: Getting this letter DOES NOT MEAN that BWC has officially decided to “allow” your claim and will pay for your medical care or lost wages.  You will be notified of that decision in the second letter from BWC, described a few paragraphs below.

The first letter includes a punch-out card with IMPORTANT INFORMATION on it:

• your claim number,
• the date of your injury - an important date to know, as it is required when you get prescriptions filled, and to set up your BWC user account to see your claim records on-line,
• the name and phone number for your Claims Service Specialist (CSS) at BWC,
• the name and phone number of the Managed Care Organization (MCO) assigned to your claim.

Keep this card with you and show it to any doctors you see for your injury.  Keep the letter with your other papers about your injury (for example, the forms your doctor and your supervisor filled out).

Paying for your medical care:  You will not have to pay the costs for any of the medical care needed for your work-related injury as long as:

• Your claim for benefits is allowed by BWC.  (As mentioned earlier, this is primarily a question of whether your injury is work-related.)
• The healthcare provider who has treated you is on BWC’s list of certified providers.  (But on the first visit you can see any healthcare provider).
• The specific medical services you have received have been authorized by your MCO.

Once BWC accepts (“allows”) your claim for benefits, you should not get any bills from any of the healthcare providers you see.

If BWC’s decision is delayed or they deny your claim, you can submit the medical bills to your regular health insurance program (if you have coverage).  If you do not have other medical benefits, you will be responsible for payment.  Most health care providers will allow you to make monthly payments or provide charity care.

Urgent medical care:  If you need medical care for your injury right away, go ahead and get it.  When you see the doctor, the staff will probably ask whether your injury is work-related, and if so they will not bill you directly as they would for a regular healthcare visit.  (But see the next paragraph.)

Pharmacy costs: The cost of medications prescribed by your doctor for your medical care is covered by workers' compensation.  Tell your pharmacist that the prescription is for workers' compensation.  Be prepared to give them your social security number, date of injury, and BWC claim number in order for them to handle the administrative requirements.

Note that you may have to pay for the first few prescriptions until your claim is "allowed", after which you will be reimbursed for those costs.  Also note that if your doctor specifies medications that are not included in the BWC formulary, you will have to pay for them yourself.

Allowing your claim:  By law, BWC can take up to 28 days to determine whether your specific circumstances and the nature of your injury meet the exact requirements of the workers’ compensation law.  The clock starts when BWC is officially notified about your injury.  Once they do decide, BWC will send you a second letter telling you whether or not they have "allowed" your claim.  This process usually takes a couple of weeks.

Additional medical care:  Soon after you file your claim, you will get at least one letter and maybe more from the MCO (Managed Care Organization) assigned to you.  The first letter will tell you their company name and how to contact them.  They provide services to you at no charge.

Your MCO can help you find a doctor or a specialist if you need one, and can help speed things up if they get bogged down.  They may also step in if they think you might not be getting the best quality of care.  And they can help you get back to work as soon as it’s safe to do so.

Medical treatment guidelines: The state has two sets of guidelines that doctors are supposed to follow.  The first one, the "treatment guidelines," lay out what kind of care produces the best results for certain kinds of injuries.  Sometimes the doctors want to do something that doesn’t match the guideline so you may need to wait until they sort that out with the MCO.

Duration guidelines:  The second set of guidelines is called duration guidelines.  Duration means the length of time people typically need for recovery after specific types of injuries.  After that point, they may still need to take it easy, but can start doing something productive again.  The duration guidelines also show how long it usually takes to get back to full duty.  If you’re not back at work soon, you may get a letter from your MCO telling you what the duration guidelines say for your particular type of injury.

Arranging return to work:  Another thing your MCO may help with is figuring out how you can stay at work or return to work while you are recovering. They will work with you, your doctor, and your employer to help you safely return to work as quickly as possible, while observing any restrictions or limitations your doctor has determined are needed to protect your health and safety, and the safety of others.