CE-1103 Filing-a-Claim

Filing a Claim To file a new notice of loss on a workers' compensation policy, select the File a Claim button from the Claims page. By default, the system will populate today's date and the policies in effect at the time of loss. You may adjust the date and time by clicking on the calendar icon: If there is another claim in the system within 72 hours of the time entered, a warning message for possible duplicate will appear. You may check your open claims on the home screen or ignore the message to continue. copperpoint.com CP-1103 Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 1 FIRST REPORT OF INJURY COMPLETED PREVIOUSLY The system will now ask if an Employer's First Report of Injury has been completed. If yes, the system will allow the user to upload the document and complete a minimized set of questions. Completing an Employer's First Report of Injury before submitting the claims online will expedite the reporting process. A link is provided to the state form. If the report has been completed, answer "Yes" and click the Upload Document button. If a report is uploaded, CopperPoint will notify the state authority as part of the claim management process. Once uploaded, your document will be renamed "Web Document" and will be acknowledged by a blue icon on screen. Please note that date/time formats must be followed exactly as the default. To prevent error, use the calendar icon to select the appropriate date, rather than overwriting the text provided. copperpoint.com CP-1103. Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 2 Continue to enter information about the incident and click the Next button to continue. Questions with an orange asterisk require a response. Some responses will require additional information: copperpoint.com CP-1103. Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 3 You may select a location of the business listed on the policy or create a new one: Additional information related to the incident can be uploaded to the file. Once uploaded, a document cannot be deleted. After entering all information, a summary screen will appear with primary information that was input (name of injured worker, date of injury, injury location, and description of event). A claim number will be generated, along with contact information of the assigned adjuster. copperpoint.com CP-1103. Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 4 FIRST REPORT OF INJURY NOT COMPLETED A loss may be reported without first completing an Employer's First Report of Injury. There will be similar screens, plus areas to describe the injury and provide additional demographic information about the injured employee. A section for affected body part(s) is also added. In this section, enter detailed information about each body part: copperpoint.com CP-1103. Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 5 If medical care was provided, complete these fields: There is also a section to provide optional witness information: The summary page will provide the same information, and the report is complete. copperpoint.com CP-1103. Revised 11.30.19. ©2020 CopperPoint Insurance Company. All rights reserved. 6