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At UPMC WorkPartners, we understand that filing a claim can seem stressful and confusing. We want to make sure your experience is smooth and positive. Our intake team is ready to provide a personalized experience for you to minimize stress. Our specialists are here to support you, address your questions, and connect you to services to support your journey back to health and safe return to work.
For Leave and Disability Claims:
You can choose from these easy ways to file a claim:
For Workers’ Compensation Claims:
You must file your claim first through your immediate supervisor/manager or company’s human resources team. Once you file your claim, you can call 1-800-633-1197 with any questions.
- Can I speak with a real person to answer my questions?
- Yes. Each claim or leave is assigned either a workers’ compensation claims adjuster or leave/disability specialist. This person will guide you through the process, paperwork, and your return to work.
- How do I file a claim?
- For workers’ compensation: Contact your immediate supervisor/manager to file your claim. It is important to report your work injury or illness to them in a timely manner.
- For leave and disability claims: If your employer opted to provide online claims submissions, you can file your claim online. Typically this information will be available on your company’s intranet site. If you have questions, please call us at 1-800-633-1197.
- Once I file a claim, what happens next?
- For workers’ compensation claims: A claims examiner will conduct a claim analysis and investigation. A compensability decision will be made within 21 days. The claims examiner can answer any questions you may have.
The Workers’ Compensation Process
- What should I do if I am injured on the job?
- Immediately report the injury to your supervisor.
- Once your employer reports your injury to UPMC WorkPartners, you’ll receive an acknowledgement letter. You may be asked to fill out forms related to your injury. Please provide as much information as possible and return the forms to UPMC WorkPartners promptly. Among the forms you may receive is a “Medical Authorization” form. This form allows UPMC WorkPartners to obtain your medical records from your treating physician. With this information, we can make a prompt determination as to your eligibility for benefits.
- You will need to get medical treatment from a provider who is on the workers’ compensation panel.
- You may also be contacted by a UPMC WorkPartners representative regarding your injury/illness.
- If you have any questions, call 1-800-633-1197.
- What is workers’ compensation?
- When a worker suffers an on-the-job injury, businesses have certain obligations. Workers’ compensation insurance covers employee expenses that are a direct result of the injury and/or illness. While plans may differ from state to state, workers’ compensation can include weekly payments in place of wages, compensation for economic loss (past and future), reimbursement or payment of medical expenses, and benefits payable to the dependents of workers killed on the job or in the course of employment. For more information on Workers’ Compensation in Pennsylvania, visit the PA Bureau of Workers’ Compensation.
- What is covered by workers’ compensation?
Benefits vary according to state. Here are some benefits that may be included as part of workers’ compensation:
All necessary and reasonable medical expenses related to your injury/illness, such as:
- Doctor visits
- Diagnostic tests
- Hospital stays
- Reimbursement for lost wages. Workers’ compensation generally provides payment for a portion of your lost wages if your injury/illness prevents you from working. You may be entitled to other additional benefits as provided by the workers’ compensation laws in your state.
- How will I know if I am entitled to receive workers’ compensation benefits?
- A claims representative will review the accident and medical reports and investigate your claim. If it is determined that your injury/illness is compensable under your state’s workers’ compensation laws, you are entitled to receive benefits. Acceptance or denial of workers’ compensation claim must occur within 21-days.
- What can I expect if my workers’ compensation claim is accepted?
- The workers’ compensation process focuses on optimum medical recovery for injured workers and return to work as soon as medically appropriate. UPMC WorkPartners works in collaboration with you, your employer, and your medical providers to help you achieve these goals. When you receive medical treatment, it is important to tell your medical provider that you are receiving treatment for a work-related injury/illness to avoid medical bills being sent to you. Your work-related prescriptions will be covered so that there is no out-of-pocket expense. To help facilitate your recovery and return to work, keep your employer and UPMC WorkPartners advised of doctor appointments and your return-to-work status. If your doctor releases you to return to work, let your employer and your claims representative know promptly. It is your responsibility to return to work when your employer has work that you are medically able to do.
- If I receive bills from medical providers for my workers’ compensation treatment, what should I do with them?
If your claim has been accepted for workers’ compensation benefits, send the bills to:
P.O. Box 2971
Pittsburgh, PA 15230
The Leave Process
- What is FMLA?
- The Family and Medical Leave Act (FMLA) provides unpaid, job-protected leave. It may help when you are unable to work because of your own serious health condition, or because you need to care for your parent, spouse, or child with a serious health condition. Leave may be taken all at once, or may be taken intermittently as the medical condition requires.
- What other leave types qualify for FMLA?
- Military Leave. You may take FMLA leave for specified reasons related to certain military deployments. Additionally, you may take up to 26 weeks of FMLA leave in a single 12-month period to care for a covered service member with a serious injury or illness.
- Bonding/adopting/foster care leave. You may take FMLA leave for the birth of a child and to bond with the newborn child, or for the placement of a child for adoption or foster care and to bond with that child. Men and women have the same right to take FMLA leave to bond with their child. It must be taken within one year of the child’s birth or placement and must be taken as a continuous block of leave unless the employer agrees to allow intermittent leave (for example, a part-time schedule).
- Who qualifies for FMLA?
Employees who have:
- Worked for their employer for at least 12 months, and
- Have worked at least 1,250 hours in the 12 months before taking the leave.
- What is a serious health condition?
These are most common serious health conditions that qualify for FMLA leave:
- Conditions requiring an overnight stay in a hospital or other medical care facility;
- Conditions that incapacitate you or your family member (for example, unable to work or attend school) for more than three consecutive days and require ongoing medical treatment (either multiple appointments with a health care provider, or a single appointment and follow-up care such as prescription medication);
- Chronic conditions that cause occasional periods when you or your family member are incapacitated and require treatment by a health care provider at least twice a year; and
- Pregnancy (including prenatal medical appointments, incapacity due to morning sickness, and medically required bed rest).
- How do I request FMLA?
- Contact UPMC WorkPartners at 1-800-633-1197. UPMC employees can request FMLA through My HUB at https://myhub.upmc.com/psp/hrpa/?cmd=login.
- How will I know if I am qualified?
- A leave specialist will contact you regarding your FMLA request and follow up with additional information in writing. This may take up to five business days.
The Disability Process
- What is covered by disability benefits?
- Disability benefits are a wage supplement that may be offered by an employer to help an employee who is medically unable to work. Not all employers offer this benefit or offer the same reimbursement level. If you need information specifically related to your employer’s short-term disability coverage, speak to your local human resources representative.
Communication with UPMC WorkPartners
- I have completed forms. Where should I send them?
Send all UPMC WorkPartners claim correspondence to:
P.O. Box 2971
Pittsburgh, PA 15230
- Who at UPMC WorkPartners should I contact if I have a change of address?
- If you have an open claim with WorkPartners and need to provide a change of address, please contact your Adjuster/Specialist directly or by calling 1-800-633-1197.
- How do I find out if my workers’ compensation check has been sent?
- Contact your claims examiner.
- I can’t remember who my claims representative is. What should I do?
- Call 1-800-633-1197 and a representative will be able to help you.