5 Dos & Don’ts of Reporting a Claim DO • Complete all pages of the injury report document (e.g. First Report of Injury Form, NSU Employee Statement Regarding Cause of Accident, CCMSI Authorization for Medical Records and Communication Release, and CCMSI False and Fraudulent Claim Warning). • Write legibly on all pages of the injury report document. • Report the injury immediately by scanning and e-mailing the injury packet to the Risk Management Office to bcharmai@nova.edu. If Dr. Beckford is on vacation, please send to risk@nova.edu | workerscomp@nova.edu. • Use (current) First Report of Injury Form for Cannon Cochran Management Services, INC. Also found online at http://www.nova.edu/risk/forms/workers-comp.pdf. • Complete all areas denoted on the sample First Report of Injury form prior to faxing or emailing the completed injury report document. • E-mail the completed injury report document to the Risk Management Office to bcharmai@nova.edu immediately after you are notified of a work-related injury. • Refer the injured employee to the NSU Employee Health Clinic (HPD), UrgentMed, or Concentra Medical. If your location is not within the vicinity of any of these medical clinics, please contact your NSU Workers’ Compensation Manager (ext. 954-262-5404) or CCMSI adjuster (407-660-5637 /1- 866‐291‐0194) for an authorized location. • Provide the employee with a copy of the completed injury report document. Don’t • Use pencils or light colored pens to complete the injury report document including the First Report of Injury form. • Use First Report of Injury Form for any other insurance company. • Fax forms with missing information.
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