Frequently Asked Questions (FAQs)

If you have a question or concern regarding WSI programs or services you may find the answer under a link in this FAQ section. If you haven’t found an answer or are an existing policyholder with questions about your account, feel free to contact our Employer Services Department via email at wsiemployerservices@nd.gov

Claims

May I pay for the worker’s injury myself and not have the worker file a claim?

No. You cannot deny your workers the right to file a claim with WSI. If you pay the claim costs “out of pocket,” you may be assuming liability for that claim and exposing your company to future medical costs and expensive litigation. Once a claim is determined to be compensable, WSI will pay benefits.

How are disability (wage replacement) benefits paid?

Disability benefits are paid at a rate of 66 2/3 of the worker’s gross weekly wage at the time of disability, not to exceed the state’s statutory maximum benefit. There is also a statutory minimum benefit. The TTD cannot go below the statutory minimum, unless the worker’s preinjury net wage was lower than the statutory minimum, in which case the worker would receive benefits equal to their preinjury net wage. Benefit checks are mailed to the injured worker.

What happens if new information has been obtained regarding a claim that has already been accepted?

Please notify WSI immediately for further investigation.

What is a prior injury questionnaire?

This is a form that is completed by the injured worker as part of the claim filing process. On this form, they list all prior injuries or health problems (whether work related or not) that they have had to the area of the body that was injured at work.

What is defined as seasonal work?

It is those occupations that are not permanent or that do not customarily operate throughout the entire year. Seasonal employment is determined by what is customary with respect to the employer at the time of injury.

The request was made for a Frequently Asked Questions (FAQ) area on our web to address the selection criteria to pick a Designated Medical Provider (DMP).

This information can be found on our website www.workforcesafety.com. Click on the Employer tab on the left side of the screen and select the Designated Medical Provider link. You will find various tips to assist with the selection of a DMP or call Employer Services for additional assistance.

The request was made to remove the doctors' portion on the First Report of Injury (FROI). It was felt that it is the employer/employees right to file the claim and they feel when the doctor initiates the claim it encourages poor reporting procedures by certain employers. Even if the doctor is being proactive it was felt it should be the employer initiating this process. It was also stated if the info submitted by the doctor is incomplete or inaccurate and they don't notify the employer that they submitted the FROI, it leaves room for a second FROI to be submitted and a duplication of claim numbers.

Much discussion went into the doctor being able to initiate the claim. This may work to the employers benefit by early reporting and the waiver of the medical assessment. WSI will notify any missing parties upon receipt of a claim regardless of who initiated the claim. The notice to the employer includes a copy of the initiating document and the employer is encouraged to notify WSI of any inaccurate information. The claims adjuster will assist in completing any information necessary for a claim decision. WSI will identify and match duplicate claim info by using an edit feature.

Some employers feel it isn't necessary for both the FROI and a C3 to be submitted for a claim. They feel it is redundant and they aren't sure why WSI requires both forms to be completed when they contain the same information?

WSI does not require the FROI and the C3. We will accept either form as a first report. Additional C3's are submitted by the provider for subsequent medical encounters.

If the employer files online but doesn't have the employee signature, WSI sends a notice requesting that information. Consequently some employers hold all forms until they have everything WSI requires and then fax the hardcopies. They wonder what WSI saves by having the online service?

The online ability to submit claims is an option for employers. It is hoped that employers and employees will sit down together to complete the FROI on line. When the employer and employee submit the information together, the signatures are waived and WSI doesn't need to request the forms. WSI encourages forms to be sent right away and not held for completion of all parts. This allows WSI early notification of the injury, early claims management leads to reduced costs and faster payments on the claim. Also early reporting by the employer can possibly waive the medical assessment.

WSI Staff identified that DMP is not defined on the current FROI form which causes a fair number of employer questions by phone when completing the form.

Educational Services spoke with the claims department who is addressing this issue. They hope to have this updated within the next few months.

There was some confusion on the steps needed to file the online First Report of Injury (FROI) form, stating the process is time consuming and confusing.

Please call your claims adjuster or our Customer Service representatives at 1-800-777-5033 and we'll be happy to assist you with any questions.

When discussing the Designated Medical Provider (DMP) program and the importance of employer interaction, the observation was shared that the doctors seem irritated when the employer accompanies the worker to the appointment.

WSI feels the employer should accompany the worker to the appointment when possible, especially in acute care situations and make themselves available for a short time after the appointment to consult with the doctor. This shows the doctor the employer is committed to providing alternate return to work (rtw) work options until the employee is able to resume their regular duties. If the doctor is resistant to working with the employer they should share their concerns with the claims adjuster.

Does WSI have any guidance for employers escorting their employee to the doctor for medical treatment?

WSI does encourage employers to escort their employees to the doctor. Unfortunately, we cannot dictate whether or not the doctor is open to them. Very seldom is an employer allowed in the actual examination room but many times the doctor will take a few minutes to visit with them following the actual appointment. If there is a particular doctor that poses problems our WSI provider relations manager will offer to provide education for medical providers regarding the importance of the employer involvement.

Is there is a way for medical providers to inform employers when an employee seeks medical treatment? Sometimes we aren't even aware there was an injury until we receive a C3 form in the mail from the provider's office. We don't feel the doctor should be able to initiate a claim from their office but rather the employer should initiate all claims.

If the employer has a designated medical provider (DMP) arrangement in place, this notification should happen naturally. If the DMP is not notifying the employer when they treat an employee then the employer may want to revisit their DMP choice or make the DMP aware of their feelings. The employer should also have internal policies in place for workers to notify them prior to seeking medical attention. If this isn't happening the employer may wish to identify consequences within their internal policy. The change to allow for claim initiation by any of the three parties (employer, injured worker, medical provider) was made after WSI began fielding complaints that the claims were not being filed timely. This process has ensured that the adjudication of the claim isn't as likely to be stalled by any one party.

Is it possible not to move adjusters around? We like the idea of having one adjuster to handle our claims.

Claim adjuster changes are only done when there has been turnover of staff at WSI or if a restructuring of case loads is necessary or appropriate.

How do you know that your claim/incident report is received or accepted when you enter it online"? Is there some way that an immediate response can be provided to the person submitting the claim, so they know it was received and they don't face untimely reporting and assessment charges?

Those using the online incident reporting feature receive an immediate electronic response showing the information they submitted along with an opportunity to print it. For online claim submissions the same confirmation message is displayed with a claim number and the opportunity to print the information. A hardcopy is mailed which includes the claim adjuster's name and a second letter is mailed once a decision is made on the claim. If the online claim submission matches an existing claim you are given that message and asked to contact WSI for the claim number.