CLAIMS

Claim Reporting Procedures


 

3 STEP PROCESS – (download the packet)

 

STEP ONE – MEDICAL CARE:

IF IT APPEARS TO THE MANAGER THAT THAT MEDICAL CARE IS NEEDED OR EMPLOYEE REQUESTS TO SEE A DOCTOR FOR A JOB-RELATED INJURY:

  1. Shift Manager instruct employee to go to (approved doctor or medical facility).
    If emergency care is required, send employee to (approved emergency medical facility)
  2. INJURED EMPLOYEE MUST TAKE WITH THEM:
    1. Authorization for Initial Treatment completed and signed by manager p.3, p.5
      NOTE: Without this authorization, the plan may not be responsible for payment.
    2. Authorization for Release of Health Information signed by injured employee p.4, p.6
      NOTE: Make a copy for the employee and retain the original signed release.
    3. Prescriptions First Fill Form completed by manager p.7, p.8
    4. Physician’s Report of Employee Injury (To be completed by Approved Provider) p.9

STEP TWO – REPORT INJURY:

TO OWNER/OPERATOR SERVICES, INC. (OOSI) AS SOON AS POSSIBLE (WITHIN 24 HOURS):

  1. If the incident meets one or more of the following reasons to report:
    Any Employee Injury, Any Alleged Incident or Injury that could conceivably develop into a claim, Lost Time Incident, Medical Attention Required, Claim Does Not Seem Legitimate
  2. Report to OOSI from a McDonald’s Restaurant:
    1. Go to your McDonald’s ISP Internet Access Page under “Reference & Learning Sites”
    2. Click on “TX Employee Injury Report” which takes you to the OOSI home page
    3. Click on “Submit Claim Online”, complete the form and Submit

CALL OOSI AT 1-800-934-9110 IF YOU ARE UNSURE HOW TO HANDLE AN INCIDENT

FOR AFTER HOURS EMERGENCIES INVOLVING SERIOUS INJURY,
CALL 1-800-834-9110 IMMEDIATELY AND LEAVE A MESSAGE ON EXTENSION 2.
DO NOT WAIT UNTIL THE NEXT BUSINESS DAY.

STEP THREE – COMPLETE & FAX REPORTS (BY END OF WORKSHIFT):

  1. Fax following completed reports to Chuck Eastwood at 210-332-1590:
    1. Employee Accident Report p.11, p.12
    2. Supervisor’s Report of Accident p.13, p.14
    3. Witness Statement(s) if applicable p.15, p.16
  2. Submit all reports to your store owner operator

If referral to another medical provider is necessary, call Chuck Eastwood with Sedgwick at 210-332-1611.

For Serious or Fatal Claims:

  • Contact police if injury is the result of a criminal act.

  • Notify family/relatives after EMS (Emergency Medical Services) is called in serious cases.

  • DO NOT commit to paying for anything (the plan can be explained later).

  • Write down the names of  all people who witnessed the incident, including customers.

  • Get every co-worker/witness to write down what they saw.

  • In fatality cases, notify the OSHA area office by the next business day.  Fill out form #OSHA 200.

  • Contact Owner/Operator Services and Sedgwick CMS immediately.

  • Preserve the accident scene/take pictures.

  • Fill out accident reports.

  • Do not speak to the media.  Use the McDonald’s Hotline (MAP) ph# 630-623-3200.

  • Be proactive.  Follow up with the next of kin.