Claims Process

First Report of Injury by:

  • Online |  Login | Register
  • Phone 1-888-346-3461, Option 1
  • Fax 407-352-5788
  • Email

Report of injury reviewed by Processing Supervisor

Managed Care

  • Managed Care RN contacts injured employee by phone to review
  • Choose Coventry Provider Medical Provider – Click here

Medical Only Adjuster

  • File is given to Medical Only Adjuster for Authorization
  • Follow-up in 90 days for closure

Lost Time Supervisor

  • Supervisor reviews report of injury and gives instructions to the Lost Time Adjuster along with notes from Managed Care RN, reserving, recorded statements and field investigation
  • File is transferred to adjuster

Lost Time Adjuster

  • Investigation begins. Three-point contact occurs — employer, employee and provider — to determine length of disability.
  • Reserves are set up and file is diaried for initial compensation payment
  • Adjuster handles maximum caseload of 135 files
  • Supervisor reviews at 30 days, 60 days and every subsequent 90 days to maintain direction on the file
  • Adjuster reviews files for any fraud indications. If fraud possible, file is forwarded to Fraud Unit for review

Cost Containment
Current Medical Savings in Excess of 40%

  • Provider sends medical bills to the adjuster for authorization
  • All bills are sent to Cost Containment for fee schedule adjusting and payment
  • All bills are pre-screened by nurses to ensure appropriateness of treatment

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