When you visit a health care provider, the provider will fill out a health plan claim form that includes diagnosis codes explaining the reason for your visit or hospital stay. When your health plan pays claims to your hospital, doctor, or other healthcare provider, our system flags diagnosis codes that are commonly related to a third party injury or illness. These diagnosis codes only give us information about the nature of the injury or illness – they do not tell us how or where the injury or illness occurred. It could have been related to a slip and fall at home, where no third party is liable or it could have occurred at work where Worker’s Compensation is required to reimburse your insurance company. Or it might have been related to a motor vehicle accident, in which case your own car insurance might be required to reimburse your health plan.
To help us understand the cause of your injury, we send you a letter asking that you provide us with more information by filling out and returning a questionnaire or giving us a telephone call. Once we receive information from you, we will either close your case or continue our work with lawyers and insurance adjusters.
You can fill out a questionnaire several different ways:
1. Fill out the form you received in the mail and send it back to us.
2. Fill out the form online by clicking here.
*You must have the username and password found on your letter to access.
3. Call (202) 683-9140.
Thank you for your cooperation. If you have any questions, please call us.
What information do I need to provide?
In most cases, if you let us know there was no third party involved (and the injury did not occur at work or as a result of a car accident) we’ll close your case and you can disregard the letter.
If a third party is liable, we’ll need information about when the accident occurred, any insurance the responsible party has, and whether you have retained an attorney.
What if I was in a car accident?
If you were in a car accident, we’ll also need information about your own auto insurance as well as any claims filed. It is often the case that auto insurance coverage will pay medical bills in the event of an accident, regardless of fault (usually referred to as Medical Payments Coverage or Personal Injury Protection Coverage). When this coverage exists, your health plan may coordinate payment of benefits with your auto insurance carrier, which is why we require this information.
What if I was injured at work?
If you have been injured at work, we need you to provide us with your workers’ compensation (OWCP for federal and postal employees) claim number and your date of injury.