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What to Do in the Event of a Workers’ Compensation Claim:
Report the Injury:
1) Online: Internet access with password (if you have forgotten your password,
please e-mail Gina at greynolds@ccmsi.com)
2) Phone: 800.628.5618
3) Fax/Mail (within 24 hours of the incident)
Send completed IL Form 45 and Transmittal Form to 630.505.3025, or mail to CCMSI, 3333 Warrenville Road, Suite 550, Lisle, IL 60532.
Whichever method you choose, please call or complete the IL Form 45 - First Report of Injury and the Transmittal Form within 24 hours of the loss.
If you have any questions or would like an updated claim packet, please contact Gina Reynolds at 800.628.5618 ext 6004.
What to Do in the Event of a Workers’ Compensation Claim:
Report the Injury:
1) Online: Internet access with password (if you have forgotten your password,
please e-mail Gina at greynolds@ccmsi.com)
2) Phone: 800.628.5618
3) Fax/Mail (within 24 hours of the incident)
Send completed IL Form 45 and Transmittal Form to 630.505.3025, or mail to CCMSI, 3333 Warrenville Road, Suite 550, Lisle, IL 60532.
Whichever method you choose, please call or complete the IL Form 45 - First Report of Injury and the Transmittal Form within 24 hours of the loss.
Claim Reporting Checklist
At the time of the incident…
1) Report the claim via Internet or by calling 800.628.5618 or by faxing an Illinois Form 45 within 24 hours of the loss to 630.505.3025. Prompt action minimizes your employees' time away from work!
2) Have the employee complete the Employee Incident Report. Get the facts while they are fresh.
3) Have the employee sign a Medical Authorization. Prompt action minimizes claim payments.
4) Report the incident to your supervisor immediately. Your supervisor should complete a Supervisor’s Investigation Report. This helps hold supervisors accountable and raises awareness to prevent future losses.
5) Complete Witness Statement(s) if anyone was present at the time of the incident. Witness(es) may be crucial to a claim if the incident and injury facts are questionable.
6) Take a photo of the accident site if needed.
3) Have the employee sign a Medical Authorization. Prompt action minimizes claim payments.
4) Report the incident to your supervisor immediately. Your supervisor should complete a Supervisor’s Investigation Report. This helps hold supervisors accountable and raises awareness to prevent future losses.
5) Complete Witness Statement(s) if anyone was present at the time of the incident. Witness(es) may be crucial to a claim if the incident and injury facts are questionable.
6) Take a photo of the accident site if needed.
Please complete the above information immediately after a loss and forward to your claim representative within 24 hours of the incident.
CCMSI
3333 Warrenville Road Suite 550
Lisle IL 60532
Phone: 800.628.5618
Fax: 630.505.3025
Benefits of WCTI Membership:
- Ownership
- Loss Prevention
- Aggressive Claims Management
- Managed Care Program
- Prescription Drug Program
- Prompt Reporting
Need more information?
If you would like additional information on this successful program, please contact Angie Blakeney at 800.252.5059, ext. 1117 or e-mail Angie at ablakeney@ccmsi.com.