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CHUBB GROUP OF INSURANCE COMPANIES

CHUBB GROUP OF INSURANCE COMPANIES California Medical Pro vider Network Important MPN Facts .. 1, 2 Four Step MPN Process .. 3 California MPN 2014 employee Notification Packet with Unique Number List .. 4 Appendix .. 5 -28 1 For any information regarding the CHUBB California MPN contact: Linda Pardee, S r. Nu rse Consultant 213-612-5363 Suzann Mcleod, Nurse Consultant 213-612-5431 smcl The Division of Workers Compensation has amended the MPN and e mployee notification regulations on August 27, 2014 allowing particip ation to be a simple p roce ss. The Me dica l Acce ss Assistance is a new se rvice in 2014 provided for CHUBB Customers by CorVel, to ident ify med ical p roviders in the MPN n et work. This servi ce is available Monday through Sa turd ay, 7am to 8pm by phone, fax or email. Employers a re no longer required to perform formal imple ment ation and all C ali fornia employee notifications.

The California MPN is an Optional Program that includes all employees within an organization for their work Comp claims. Employee MPN Information Notification Packet

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Transcription of CHUBB GROUP OF INSURANCE COMPANIES

1 CHUBB GROUP OF INSURANCE COMPANIES California Medical Pro vider Network Important MPN Facts .. 1, 2 Four Step MPN Process .. 3 California MPN 2014 employee Notification Packet with Unique Number List .. 4 Appendix .. 5 -28 1 For any information regarding the CHUBB California MPN contact: Linda Pardee, S r. Nu rse Consultant 213-612-5363 Suzann Mcleod, Nurse Consultant 213-612-5431 smcl The Division of Workers Compensation has amended the MPN and e mployee notification regulations on August 27, 2014 allowing particip ation to be a simple p roce ss. The Me dica l Acce ss Assistance is a new se rvice in 2014 provided for CHUBB Customers by CorVel, to ident ify med ical p roviders in the MPN n et work. This servi ce is available Monday through Sa turd ay, 7am to 8pm by phone, fax or email. Employers a re no longer required to perform formal imple ment ation and all C ali fornia employee notifications.

2 The MPN notification only needs to be provided to an employee reporting an in jury. I t s t ha t s imple ! I t is r ecommended that you review the DW C w ebsite: for a ccess to very use ful in formation for the employee and employer on Workers Compensation. DWC-7 Posting Notice Must BE PO STED B Y ALL EMPLOYERS, regar dless if they a re in t he MP N or not. It is not mand atory to have an MPN, but it is recommended. The Posting Notice must be placed in a conspicuous location where a ll e mployees have access. This document should be replaced and updated yea r at policy period start dat e. http:/ Medical Access Assistance Availa ble toll free 7am to 8pm Monday thro ugh Saturd ay in English and Spanish to provide acce ss to medical c are provid ers in the MPN. Phone: 855-857-7556 Fax: 866-708-4331 Email: DWC-1 employee Claim form Must be completed by every employee at the ti me they report a Workers Compensation injury.

3 Upd ated in 2010, located a t the DWC w ebsite: http:/ rms/C Pre-Designation of Personal Physician Form Empl oye rs a re to provide this to New Hire and all e mployees who request choice of their pe rson al phy sici an for medica l c are of their WC claim. The employee must complete, sign, obtain their phy sici an signature on the form, providing to their e mploye r p rior to reporting a Workers Comp injury. Up da ted Febru ary 2014, loca ted at: http:/ Time of Hire Pamphlet Provides info rmation to Ne w Employ ees about Workers Compensation and includes the Pre- De signation of Prima ry Physici an and Notice of Pe rsonal Chiropractor or Person al Acupuncturist forms. Notice of Personal Chiropractor or Personal Acupuncturist Form Empl oy ees choosing to use their perso nal Chiropractor or Acupuncturist must sign and return 2 this document to their employer prior to reporting a claim.

4 Chirop ractors are limited to no more than 24 visits as Prima ry Treating Phy sici an. The Cali fornia MPN is an Optional Progra m tha t includes all e mployee s w ithin an organization for their wo rk Comp claims. employee MPN Information Notification Packe t provides information to the employee rega rdi ng t he MP N p rogr am. As of August 27, 2014 the packet has changed r equiring a Unique MPN number affixed to the document, in addition to the re cently added MPN Access Assistant cont act info rmation. If your company has been util izing a packet provided prior to October 2014, you will need to obtain the newer v ersion with the MPN number. If you have any questions please contact us for assistance, we are he re to help. CHUBB MPN Contacts Linda Pardee, Sr. Nurse Consultant 213-612-5363 Suzann Mcleod, Nurse Consultant 213-612-5431 CorVel MPN Contact Jacob Seehoffer 800-966-5307 jacob_seehoffer@corvel.

5 Com employee MPN Packet Information Th e Cali for ni a W or ker s Compensation Regulation requires employees to utiliz e the Medi cal Prov ider Networ k (doctor s, hospitals, anci llary service s) who are part of a Medical Provider Networ k or MPN. The Medical Provider Net wor k h as b een selected for treatment of work related i njuri es. Employer Contact: Contact Name: Jacob Seehoffe r, CorVel 87 7- 533-7768 MPN Assistance: 7 Address: 1 100 Town & Country Road, Suite 400 City, State, Zip: Orange, CA 928 68 Things to consider: Number of California employees P roximity of l oc ations to available cli nics S taff available to implement, support and monitor the MPN p rogr am Cost savings involved with contract clinic use for the life of a claim CHUBB claims staff p rovide support to manage the ongoing medi ca l ev ents of WC claims Litigat ed cases have reduced capability to e xit ne twork If you choose the MPN Medical care will rema in wi thin the network for the life of the clai m.

6 If you choose not to use the MPN Empl oye r di rects the Injured Worker to the Prima ry Care Clinic of their cho ice for the first 30 days after a claim is reported. After 30 days t he e mployee can seek medical ca re with the provider of th eir choice fo r the life of the claim. 3 CALIFORNIA MPN Implementation Instructio ns FOUR STEP MPN PROCESS STEP ONE SELECT YOUR MPN There are three options when making a decision about the California MPN. You may choose only one option. 1) CorVel MPN 2) CHUBB Kaiser Select MPN 3) Cessation of a California M PN program STEP TWO Post the MPN information on DWC-7 Posting Notice DWC-7 Posting Notice Information CUR RENT MP N T OL L FREE NUMBER: 800-966-5307 (CorVel NDB - National D ataba se Unit) CorVel MPN WEBSITE: OR CorVe l / Ka iser MP N WEBSITE: r/ MP N E FF ECTIV E D ATE: (Date MPN is posted on DWC 7 notice) CUR RENT MP N ADD RES S: 1100 Town & Country, Suite 400 Orange CA 92868 CLAIMS ADMINISTRATOR: CHUBB GROUP of INSURANCE COMPANIES PHO NE: 800-262-4459 WORKERS' COMPENSATION I NSURER: CHUBB GROUP of INSURANCE COMPANIES PO LICY E XPI RATI ON DATE: DWC OFFICES: STEP THREE Provide the employee Information/Notification Packet when a n Injury is Reporte d New documents require Unique MPN number in top left corner.

7 (See next page for listing of these documents according to CHUBB Writing Company and MPN selection) STEP FOUR When a n employee Reports an Injury (Report a ll claims timely) Provide the employee : 1. Copy of employee MPN Information packet. Obt ain signature on acknowl edge ment and provide to CHUBB . 2. Copy of the Workers' Compensation Claim Form (DWC-1). http:/ 3. Express Scripts Temporary Prescription Services ID (See Page 8a) 4 4. Completed Job Description (See page 9b) 5. Work Abili ty Form (See Pa ge 9c) The employee should be sent for a medical evaluation at a chosen MPN clinic or nearest emergency ro om. California MPN 2014 employee Notification Packet, with Unique Number: CorVel MPN Notifications 0265 Northwestern Pacific 0266 Pacific Indemnity 0267 Federal INSURANCE 0268 Vigilant INSURANCE 0269 Great Northern INSURANCE 0270 CHUBB Indemnity 0271 CHUBB National 0272 Executive Risk Indemnity Kaiser Select MPN 1471 Vigilant INSURANCE 1472 CHUBB Indemnity 1473 Pacific Indemnity 1475 Executive Risk Indemnity 1476 Federal INSURANCE 1477 Great Northern INSURANCE 1478 Northwestern Pacific 1479 CHUBB National To download the applicable MPN employee Notification Packet, visit: 5 CHUBB GROUP OF INSURANCE COMPANIES APPENDIX MPN LOOK-UP CorVel MPN Look-Up Instruct io ns.

8 6-7 CHUBB / Kais er Se lect Look Up Instructions .. 8 employee MPN NOTIFICATION PACKET CA CorVel MPN English ( Example ONLY).. 9-14 MPN Medical Acce ss Line 15 CALIFORNIA POSTING Information DWC-7 Po sti ng Notice .. 16- 17 DWC-1 Claim Fo rm .. 18- 20 DWC WEBSITE DWC Time of Hi re P am phl et 21-26 htt ps:// a. gov/dwc/DWCPa mphlets/TimeOfHirePa Pre Designatio n of P ersonal Ph ysician 27 htt ps:// a. gov/dwc/FORMS /DWCForm_97 htt ps:// a. gov/dwc/FORMS /DWCForm_9783_Spanis Noti ce of Pe rsonal Chiropractor/ Acupunc turist 28 htt ps:// a. gov/dwc/FORMS htt ps:// a. gov/dwc/FORMS /DWCForm_978 3_1_span CWCI Store 6 CORVEL MPN - Look-Up Instructions March 20, 2014 CORVEL S WEBSITE California MPN PROVIDER LOOK-UP PROCEDURE: 1) Go to 2) Click Search under Find a Provider . 3) In the Select a Network , click on the down arrow th at wi ll r evea l sev era l selections.

9 In that drop down menu, select California MPN 4) Put in your location Zip Code 5) In Specialty Box, sel ect Occupational Medici ne. 7) A M ap will come up showing the zip code a rea you selected with a li sting of various clinics. (I f no clinics are li sted, you may have to modify the maxim um driving distance to a l arge r radius in the location area.) MPN ID# 0267 7 8) Be sure to ca ll the providers to verify they a re sti ll in the designa ted lo cation. As with any Web Da tab ase, some information may be outdated. MPN ID# 0267 8 CHUBB /Kaiser Select MPN Look-Up Instructions (March 20, 2014) 1) Go to: r/ 2) Enter Search Criteria: Zip code of your lo cation 3) Specialties: Occupational M edicine 4) Maximum Distance: Zip co de of your location drop down box allows you to use 5 miles m in. 50 mi les m ax.

10 5) Click Find Providers: For a listing of all Kaiser Providers for the State of CA: In the Enter Sea rch Cr iteria: 1. Type Kais er On-the-Job in the Name box 2. Sea rch Method: W ithin a Sta te 3. Click: Find Providers. MPN ID# 0267 9 MPN Contact Name: Jacob Seehoffer Telephone Number: Address: 1100 W. Town and Country Rd., Ste. 400 City, State, Zip: Orange, CA 92868 EXAMPLE DOCUMENT NOT FOR employee USE employee MPN INFORMATION Th is info rmati on is b eing provided to you to exp lain your rights and responsibilities should you have an accident at wo rk. You will also receive a copy of t his notice at the time of injury. Unle ss you are authorized to tr eat outside the Medical Provider Network (MPN), medical tre atment for work related injuries will be covered under the Medical Provider Network. The Medical Provider Network has been selected for treatment of work relat ed injuries.


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