AmTrust and Technology
AmTrust has always been committed to using evolving technology to make it easier for our customers to interact with us and access vital information related to their insurance policies:
- Automated claims systems
- Paperless claim filings and electronic claims notes
- Claims reporting hotline
- Direct phone line and email access to all claims adjusters
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How to File a Claim
Step 1: The employee reports an injury to the employer
Assess the
condition of the injured worker. The employee should seek medical attention right away for a serious or life-threatening injury. If it is a non-emergency, the employee should visit a medical provider designated by the employer.
Step 2: The employer files the claim with their insurance carrier
Upon receipt of the work injury, a supervisor (or HR representative) should provide the necessary paperwork to the employee and report the injury to the company’s workers’ compensation insurance provider. All injuries, from minor to major, should be reported within 24 hours of the incident.
Step 3: The insurer will either approve or deny the claim
The workers’ compensation insurance carrier will determine whether a claim is approved or denied based on the circumstances around the injury.
Step 4: Continue receiving medical treatment and monitor the status of your claim
The employee continues receiving treatment and may follow up on the status of their claim periodically.
Step 5: The employee returns to work
Once the injured employee is healthy enough, he or she will return to work (either full-time or in a limited role) unless the injury leaves them totally disabled.
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How to Report a Claim
Policyholders should file all claims regardless of whether or not they think the employee injury is work-related. The first report of injury (FROI) can be reported by the policyholder or agent online via
AmTrust Online, via fax or by phone.
24/7 Toll-Free Claim Reporting for ALL States
Phone: (866) 272-9267
Fax: (775) 908-3724 or (877) 669-9140
Email:
Amtrustclaims@qrm-inc.com
When reporting any type of claim the following information is required:
- Name of the insured and policy number
- Date, time & place of accident
- Description of accident or incident
- Name, phone and/or e-mail of person making the report
See below for additional required information for our different policies:
For Workers’ Compensation:
- MUST have the injured employee’s social security number as it is required by law
- Description of injury
For Property Claims:
- Physical address of the loss
- If more than one building on property, please list the specific building(s) involved
- Type of loss, i.e., fire, theft, etc.
- Description of loss or damage
For Motor Vehicle (Auto) Claims:
- Name, address and contact information of ALL parties involved
- Make, model and VIN of the insured vehicle
- Make and model of all other vehicles involved
- Current location of all vehicles
- Name and contact information for each driver and all passengers
- Name and contact information any known witnesses
For General Liability Claims:
- Physical address of where the loss occurred
- Name, address and contact information for all persons claiming injury or damage
- Name and contact information of any known witnesses
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Disability Claims
New York DBL Claims:
The forms required when an employee becomes disabled in NY and may be entitled to disability benefits are:
- DB-271S—Statement of Rights: The NY DBL law requires an employer to send a “Statement of Rights” – entitlement of benefits under the Disability Benefits Law to an employee, within five days after the employee has been absent from work for more than seven consecutive days. This statement is in standardized format approved by the Workers' Compensation Board.
- DB-450—Notice and Proof of Claim: After the disability begins, Part A – Claimant and Part B – Health Care Provider statements should be completed, signed and the form returned to the employer for completion of Part C – Employer Statement. The form should then be submitted to Wesco Insurance Company. Claims should be filed within 30 days after the employee last worked and the physician has certified the employee is totally disabled. Failure to submit the claim within 30 days may result in a partial or total rejection of the claim.
New Jersey TDB Claims:
The forms required when an employee in NJ becomes disabled and may be entitled to disability benefits is:
- DS-I – Division of Temporary Disability Insurance Claim for Disability Benefits: Claim form is used to file a New Jersey TDB claim when an employee becomes totally disabled while employed. Claim must be filed within 30 days of disability. The employer must send the employee a Disability Form (Form DS-1), containing the worker’s name, address, Social Security number and wage information needed to determine the worker’s eligibility for temporary disability benefits.
Send a completed claim form for NY and NJ to:
Wesco Insurance Company
PO Box 980, Bowling Green Station
New York, NY 10274
Fax: 800-584-9303
Email:
DBClaims@amtrustgroup.com
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Claims Process
The claims process could vary depending on the type of claim. File all claims, regardless of whether or not you think it work-related. Claims should be filed as soon as possible, within 24-hours if possible. They can be filed the same day as the incident up to 90 days later, depending on your state regulations.
If it is determined to be a workers’ compensation claim, AmTrust is responsible for 100% of the work-related medical costs. Once the value of the loss or injury is determined, AmTrust will resolve the claim.
After a claim is submitted, it is reviewed and assigned to an adjuster, who makes three contacts: employee, employer and medical provider. The adjuster will follow up with questions for all contacts about the incident.
Based on state regulations, an employee can seek treatment with a network physician (employer approved) or they can choose their own doctor. The physician will determine the diagnosis, cause of relationship, expected length of disability and physical capabilities.
If an employee is severely injured, the AmTrust Complex Claims team handles the claim to make sure the employee has the best care upfront with creative plans tailored to the immediate and specific needs of each claim. Complex claims are high exposure claims with complicated medical, legal, or coverage decisions that require a high level of technical skill.
Return to work options are initiated through a joint effort among the employer, physician and injured employee.
Return to work programs are a proactive way to help injured employees return to their full potential on the job as quickly and safely as possible. They are an efficient way for employers, employees, healthcare providers and claim administrators to manage the workplace injury rehabilitation process.
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