Resources

Through Sedgwick Employer Accident Report Portal, named users may upload claim related documents.  When uploading documents  they should be uploaded separately.  Do not bundle multiple types of documents or claims.  For example, a medical note(s) should be uploaded and the file type and description noted as such, without any non-medical notes included. A wage chart being uploaded the same day should be uploaded separately and described as a wage statement.

If you do not have rights to upload information via VLW Sedgwick Employer Accident Report Portal, you may email claims related documents to US-YORK-covimaging@sedgwick.com   

If you are emailing documents, please send to US-YORK-covimaging@sedgwick.com ONLY. Do not send emails with attachments directly to the benefit coordinator. If you are emailing as a way of communicating with the benefit coordinator and your email does not include attachments, send the email to the benefit coordinator ONLY. Please do not copy US-YORK-covimaging@sedgwick.com.

Gross wages plus any perquisites like bonuses, meals, lodging or uniforms. 

Gross wages for the 52 weeks prior to the date of injury plus any perquisites like bonuses, meals, lodging or uniforms.  If the employee has worked less than 12 months, then report wages since the date of hire.  The Benefit Coordinator may request the wages of a similar employee if the employee has worked less than 60 days. 

Photographs should be submitted when confirmation of a hazard is needed to support an injured worker’s claim, i.e., areas of slips, falls, defects, etc.  Photographs should be submitted either via the attachment feature within Sedgwick-Employer Accident Report Portal or if you are not a named user in that system, you may send to US-YORK-covimaging@sedgwick.com.   

A Supplementary Report is no longer required. However, it is the agency’s responsibility to communicate with the assigned benefit coordinator any time there is a change in the injured worker’s work status which results in lost time or return to work and will affect the amount of indemnity benefits the injured worker is owed. The Supplementary Report or some other form of communication should be submitted to MCI at the same time the lost work hours or return to work is reported to HR/payroll.

If the claim is accepted as compensable for an occupational disease then initial testing and six-month follow-up for testing will be covered under workers' compensation.  However, OSHA has separate guidelines for post exposure evaluations and follow-ups for all employees who had an exposure incident at work.  The requirements established by OSHA are separate from workers' compensation.  

Claims are reported electronically through Sedgwick’s FROI Portal.

All the information you have in your possession at the time the claim is submitted through Sedgwick’s FROI Portal.  The comments field should be used to document any additional information that will not be a part of the Employer’s Accident Report. Please make sure to include either a direct line phone number for the agency contact or the extension of the contact person.

This information can be reported directly to the Benefit Coordinator assigned to the claim. 

They are both state agencies. The Commonwealth of Virginia Department of Human Resource Services (COV-DHRM) manages with its partner, MC Innovations (MCI), the Workers’ Compensation claims made by employees of the Commonwealth of Virginia.  If a workers’ compensation claim related disagreement arises between a COV Agency employee and MCI, the Virginia Workers’ Compensation Commission (VWCC) will review the claim.  VWCC has authority over Workers’ Compensation claims within Virginia from both COV and non-COV employers / employees.

A valid physician panel will include three physicians for each specialty listed who are not within the same practice.

 

For more help/information see the How to Develop a Panel of Physicians Guide.

If the injured worker has been taken out of work for over 7 days due to the incident, or if there is a serious injury for which you have not received medical documentation but anticipate that the time missed from work will be over 7 days, the claim should be classified as Indemnity.

If there has been medical treatment but no time missed from work or 7 days or less missed from work, the claim should be classified as Medical Only.  Medical treatment includes any visits to any doctor’s office or to an emergency room.

If there has been no medical treatment nor anticipated, then the claim should be classified as Record Only.

If an employee alleges an injury at work, but has received no medical treatment, the claim should be reported as Indemnity or Medical Only based on the amount of time lost from work as noted above.