CLAIMS

We’ve got you covered when it comes to filing claims.

It’s essential that you report every workplace injury immediately. It’s the only way to make sure you stay within reporting requirements and avoid potential fines. Additionally, the sooner you report an incident, the sooner your claims manager can begin guiding you through the claims process.

In the state of Nevada, you must complete the C-3 Form within 6 working days of the injury.

In the state of California, you must complete the DWC-1 and 5020 Forms within 5 days of knowledge of every occupational injury or illness which results in lost time beyond the date of the incident, or requires medical treatment beyond first aid.

If an injury occurs, contact your Claims Services Administrator right away.

Below is a list of your claims providers by program – they should be your first contact after ensuring the injured worker has received the proper medical attention. Follow the links for forms and step-by-step instructions on how to file a claim with your provider.

For policyholders of:

Companion Property & Casualty Insurance Company
Companion Commercial Insurance Company
Nevada Mutual Insurance Company

Contact:

S&C Claims Services, Inc.

Forms:

General

Finding a medical Provider

Northern Nevada
Southern Nevada

pdf-iconEmployer’s Initial Report of Injury – NV-C3

pdf-iconEmployer’s First Report of Injury – NV-C4

pdf-iconStep-by-step instructions on how to file your claim

 

Mailing Address:

S&C Claims Services, Inc.
9075 W. Diablo Dr #140
Las Vegas, NV 89148

Phone:

702.873.5115

Toll Free:

800.362.5198

24 Hour Emergency Claims

Reporting Hotline:

800.289.4502

Fax:

702.876.5584

Email:

Website:

www.scclaimslv.com

Staff:

Dave Oakden, Operations Manager
Julie Wood, Claims Supervisor
Kimberly Larkin, Claims Examiner
Veronica Munoz, Medical Only Claims Examiner (Bilingual)

ProSight Specialty Insurance
New York Marine & General Insurance Company

In all states except California, contact:

Sedwick CMS

Forms:

General

pdf-iconFinding a medical Provider

pdf-iconTemporary Prescription ID Sheet

Employer’s Initial Report of Injury

pdf-iconNevada C3

pdf-iconUtah Form 122

pdf-iconIdaho IC Form IA-1

pdf-iconArizona Form ICA 04-0101

Employer’s First Report of Injury

pdf-iconNevada C-4

pdf-iconArizona Form ICA-04-0407

pdf-iconStep-by-step instructions on how to file your claim

 

Mailing Address:

Sedwick CMS
P.O. Box 14437
Lexington, KY 40512

Phone:

800.774.2755
(Call centers are open 24/7)
Press ‘1’ to report a claim
Press ‘2’ to inquire about a claim

Fax:

866.366.0446

Email:

3487ProSight@sedgwickcms.com

Website:

https://www.sedgwickcms.com 

Please reference your contract number of 3487 and the Unit Number (last 8 digits of your policy number)


In California contact:

LWP Claim Services

General

pdf-iconFinding A Medical Provider

Employer’s Initial Report of Injury

pdf-iconCalifornia 5020

Employee’s First Report of Injury

pdf-iconCalifornia DWC-I

pdf-iconStep-by-step instructions on how to file your claim

 

Mailing Address:

LWP Claim Services
P.O. Box 0000

Phone:

800.000.0000

Fax: 

000.000.000

Email:

Website: