Billing Information

Payments can be processed as follows:


In the Event of an Employee Injury

If your employee’s need for treatment appears urgent — for example, bleeding profusely, unconscious or may be having a heart attack — get them to the nearest emergency room or call 9-1-1.

For non-emergency services, you must approve treatment at a Medical Provider Network (MPN) facility within one working day after you receive a claim form from your employee.

Note: If your employee has pre-designated a personal physician to treat on-the job injury or illness, the employee should go to this physician.

Click here to search for a provider within ICW’s Medical Provider Network

ICW representatives can assist you with completing the required claim forms by calling them at (877) 442-9669

The Employers First Report of Injury (Form 5020) is to be completed by the employer and can be downloaded here

The Workers Compensation Insurance Claim Form (DWC1) is to be provided to the injured employee within one working day after learning about the employee’s work injury or illness.

The employee should complete the Employee section and return the form to you.  Upon receiving the completed DWC1 form from your employee, provide them with a copy within one day and submit a copy to ICW Group, while keeping one copy for your records.

Submit applicable forms as follows:


Mail

First Notice of Loss
PO Box 509039
San Diego, CA 92150

If the injury or illness is deemed serious or results in death, it is your duty to report to Cal/OSHA.

Click here to learn more about Cal/OSHA requirements


Policyholder Tools

ICW provides their policyholders with tools and resources that can help in the following areas:

  • HR OnDemand – Get HR advice from a team of experienced human resource advisors
  • Webinars, training videos and more to help improve your company’s safety culture