Reporting Claims

 

 

EFFECTIVE 8/1/11 - CRAWFORD

 

 

All Property Claims (Crawford & Company):  

 

ONLINE FIRST NOTICE OF PROPERTY LOSS FORM - http:apps.ficurma.org/fnpl

 

 

 

 

EFFECTIVE 12/1/08 - PMA

 

 

All WC & ALL Liability Categories (Auto, GL & PL)  

 

PDF VERSION   

 

PMA MANAGEMENT CORP. (effective 12/1/08)

 

 

PREFERRED METHOD -  REPORT VIA THE INTERNET:

 

To file a First Report of Injury or Accident electronically go to PMA’s website, www.pmagroup.com

  1. Click on the icon “Report a Claim”

  2. Fill in your User Name and your password.  Your PMA account number is your User Name, which is Acct # 2499309 your password is “newclaim”.

  3. Simply select the type of claim being reported (i.e.: “Workers Compensation or Liability (GL, Auto or PL).”

  4. Select your location from the drop down menu.

  5. Complete the screens that are presented.  The mandatory fields (information required to begin the claim review process) are highlighted in blue.

  6. If you would like to receive an email copy of the information you have provided (along with the claim number that you are assigned), on the last screen check “Send email copy to originator” and enter your email address in the space provided.

  7. Click on the “SUBMIT CLAIM” button and your claim will be transmitted to our claim processing offices.  You will receive an immediate claim number for your WC and/or Liability claim.

 

Any questions or problems reporting via the internet, contact your Client Service Manager:  Maggie Conatser (813) 207-4452, Cell (813) 480-1072

 

 

REPORT VIA THE PHONE OR FAX:

 

Call:  888-476-2669 (PMA Management Corp. Call Center) FICURMA Client Number:  2499309

 

 

OR

 

 

FAX to 888-329-2721

If faxing please include your account number listed above on the first report of injury.

 

 

Questions about a claim, or to inquire about a payment:

To call about the status of a payment, contact the PMA Customer Service Center at:   1-888-476-2669

Or your Client Service Manager:   Liz Smith (813) 207-4197, Cell (813) 545-1071

 

 

NEW MAILING ADDRESS FOR ALL PMA CLAIMS CORRESPONDENCE (EXCEPT PROPERTY)

 

PMA Customer Service Center

PO Box 5231

Janesville, WI 53547-5231

 

 

PMA Claim Forms

 

Worker's Compensation Treatment Authorization Form

Injured Worker's Tmesys First Fill Prescription Information Sheet

False or Fraudulent Claim Warning

Medical Records Release Authorization

PMA Fax Transmittal Sheet

DFS-F2-DWC-1a (Wage Statement)

The Florida Division of Workers' Compensation has updated the Forms Web page to include recent changes made as a result of revisions to Rule 69L-3, effective March 16, 2009. Forms were revised to comply with the revision of Section 119.071(5), F.S. (2007) that precludes an agency from collecting an individual's social security number unless such collection conforms to the specific provisions of that statute.

 

Forms DFS-F2-DWC-1a (Wage Statement) and DFS-F2-DWC-30 (Authorization and Request for Unemployment Compensation Information) are amended so that the collection of the social security number is discontinued.

 

To assist with the change, PMAMC has placed the DWC1A on an excel spreadsheet, allowing the information to be placed directly on the spreadsheet and automatically calculate the totals.  Please continue to return the completed form to the handling adjuster by e-mail and/or fax.

 

In the event you are currently receiving the acknowledgement letters by mail along with the DWC1A (Wage Statement), please disregard and use the above form.

 

Should you have any questions, please contact:

 

Maggie Conatser

FICURMA

Office: 813-929-6691 ext 3

Cell:  813-210-7687