Telephonic Claims Reporting


TO: The Workers’ Compensation Coordinators:

To assist you in the reporting of Workers’ Compensation injuries, The School Districts Insurance Consortium will continue to provide you with a supply of claim reporting packets. These packets contain all forms and information that you as well as the injured employee will need to begin the process.

Please, enclose a copy of your most current “Posted Panel” for the employee.

These packets are to be used each time an employee reports “any” injury. The packets contain the following:

  • Medical Authorization
  • Employee/Witness/Supervisor Statement
  • Instructions for claims reporting
  • Employee’s Rights and Duties Form(For use with the Posted Panel of Providers)
  • Prescription Program Information.
  • The “First Fill” pharmacy sheet is used to fill prescriptions at the local pharmacy. (The Mitchell International) Company is our prescription management company.)

Please fill in the medical release form for the employee and have this form signed by the injured worker as well as the Employee’s Rights and Duties Notice. This is required by the Provisions of ACT 57, Workers’ Compensation Law. Please provide the employee with copies of these two documents. The employee’s personalized prescription card will follow from our Prescription Management Company, “Mitchell International “. Mitchell International will handle all prescription needs including (DME) durable medical equipment.

Please advise the employee that all the information they require to report a claim and begin the process is enclosed in the packet you are providing.

Your SDIC team will call you after you have received your packets to insure that you understand how they are to be utilized.

Should there be “any” questions, please call our offices. We are at your service!