Workers' Compensation Managed Care Policies & Procedures for Employees
What to do if you are injured on the job
Report Injuries
Notify your employer as soon as an injury occurs! Your employer and your doctor will notify us of your injury. Once an injury has been reported, then Spooner Medical Administrators will call you to see how you are doing and to help you with your return to work.
Obtain your Identification Card
You should have an identification card specifically for workers' compensation coverage. The identification card has your employers' name and their Bureau of Workers’ Compensation (BWC) account number. The card also provides important phone numbers, including where to call to report an injury. You must show your identification card when you go for treatment. If you need a card, then contact your employer.
Getting Treatment
Your doctor must obtain approval for all treatment beyond the initial visit. If your doctor feels that a referral is needed for specialist care or other services, then he/she should refer you to a doctor certified by the BWC. All referrals and treatment must have prior authorization. All medical treatment requests will be reviewed to ensure appropriateness for your injury. You can appeal any treatment reimbursement decision made by Spooner Medical Administrators. Contact Spooner Medical Administrators for information regarding referrals and prior authorization.
Choosing a Medical Provider
Spooner Medical Administrators works with excellent BWC certified doctors who share the goal of providing quality medical treatment and returning workers to the job safely. If needed, Spooner Medical Administrators can assist you with finding a doctor. Telephone referrals will be available from Spooner Medical Administrators, Inc. during office hours: Weekdays 8:00 AM - 5:00 PM.
You may seek care from:
- BWC certified physicians
- Any physician, but if he/she isn't BWC certified, then you may be liable for your medical bills.
Contact Spooner Medical Administrators to determine if a physician is BWC certified.
Payment of Medical Bills
You are not required to pay the doctor for approved treatment for your allowed workers' compensation claim. Keep in mind that only the BWC can determine whether or not your workers' compensation claim is allowed and for what medical conditions. Spooner Medical Administrators cannot pay your medical bills until this decision is made by the BWC. If you have paid for medical services out of your own pocket for a BWC certified provider for an allowed workers' compensation claim, then you can apply for reimbursement by sending the bill and proof of payment to Spooner Medical Administrators.
If you are expecting to receive a compensation check for lost work time, then this will be processed by the BWC. Contact the BWC with any questions regarding lost wages.
The Role of Employees in a Return to Work Program
Your role is to report an injury to your supervisor immediately and be treated by a BWC certified provider. You should also work with Spooner Medical Administrators to make sure your claim is managed correctly and you return to work quickly and safely.
The Role of Spooner Medical Administrators
Spooner Medical Administrators, Incorporated is a managed care organization authorized by the BWC to provide employees with medical management services. Our services include case management, prior authorization of medical treatment and payment of medical bills. Contact Spooner Medical Administrators with any question you have about your claim or the workers’ compensation process.
Contact Us:
Fill out the form below to contact us. To report claims or for claim information call us 440-899-2400 or 800-542-9479.
