Triad Group is committed to provide Employers with comprehensive claims management and outstanding customer service. Our relationship begins with the creation of a customized plan that suits your needs. We then establish points of contact within your organization as well as ours to ensure that the lines of communication are always open. From there, you can rest assured that your claims will be handled with care and precision at minimum cost.
One of the most important elements of Claims Management is timeliness. The sooner you report an incident to us, the better. When an incident is reported immediately, it makes it much easier for us to handle it effectively. We can then assign case management, investigation or any other intervention that would appropriate. This also allows us to initiate diagnostic studies to evaluate need for further treatment and expedite the claimant’s return work. Click here to see a sample C-2F, which should be completed by the injured worker’s supervisor and submitted to Triad ASAP. In compliance with Workers Compensation Board requirements, an injured worker will be given a claimant information packet which will provide them with paperwork to be completed. This packet will also inform them which Provider Networks should be used for diagnostic testing and prescription medication.
The Workers Compensation Board will require Forms that detail the claimant’s payroll information and time lost from work. These forms are completed by the Employer, and submitted to Triad. They are Forms C-11, C-240, C-107. A C-11 and C-2F is the employer’s report that the claimant is losing time as a result of the injury. A C-240 shows the payroll of the claimant for one year prior to the date of injury. A C-107 is a request for reimbursement for wages paid. Sometimes the Board will request updated Forms even though the information has not changed. This can be a tedious process. However, failure to comply could result in penalty, so it is important that these Forms are completed and submitted upon request.
You have experienced an on-the-job injury. Now what? First, you need to report your injury to your Supervisor. They will fill out a C-2F form and submit it to us. You will be given a claimant information packet. This packet contains information for your records as well as Forms that you will need to fill out. If your injury requires medical treatment beyond first aid, make sure to inform your medical provider that this was a Workers’ Compensation injury. DO NOT BILL ANYTHING THROUGH YOUR PRIVATE INSURANCE. DO NOT PAY FOR ANYTHING OUT OF POCKET.
Once your injury has been reported to us, you will be assigned a Carrier Case Number (Claim Number). Give this number to your medical provider so that they can bill us properly. You will receive a prescription card from our vendor PMSI/Tmesys for any medications you may need as a result of your injury. This card is accepted at most pharmacies for your convenience. The more information we have, the better able we are to ensure that you receive the care you need.
You will receive a card in the mail from our prescription vendor AWPRx. Use of the card will eliminate any copay or other charge to you. We can arrange home delivery if you would like. If you wish to use your AWPRx card, or accept home delivery via AWPRx, simply use your card. However, this is strictly VOLUNTARY. Any pharmacy can fill your related and necessary prescriptions. Just show the Triad card with our contact information or ask the pharmacy to call our main number 800-337-7419 and press Zero. If you require diagnostic testing such as an MRI or EMG, you have the option to schedule your test within 48 hours through our network, One Call Care Management by calling (800) 872-2875.
If you would like a friend or family member to be able to communicate with us concerning your claim, please execute this form and forward to us via fax or e-mail.
Did you know that there are specially trained medical providers who can provide you with the best available medical care at no cost or out of pocket expense to you? Click here to learn more about the World Trade Center Health Program.
The Triad Group has a designated WTC administrator, Maryellen Hetzer, to address any issues that arise during the transition. They will serve as the claimants' first point of contact for all claim administration issues and can be reached at:
Triad staff attorneys and hearing specialists work closely with attorneys and representatives of injured workers and outside counsel selected by Triad and our clients to avoid unnecessary litigation and control expenses. Many functions typically referred to outside counsel are handled in house by our own professional staff. This improves communication, expedites resolutions and benefits both our clients and their injured employees.
If you are an attorney or representative and are interested in partnering with us, please contact us.
Beginning in December 2010, the New York State Workers’ Compensation Board began using new Medical Treatment Guidelines. The MTG program includes four comprehensive, evidence based guidelines for the treatment of injuries and illnesses involving the neck, back, shoulder and knee. These guidelines were the mandatory standard of care for dates of service on or after December 1, 2010. On March 1, 2013, the Carpal Tunnel Syndrome Guidelines, updated versions of the current MTGs and a new maintenance care program were adopted. Click here for more information from the Workers’ Compensation Board.
When calling for status of a medical bill, please have as much information as possible (Claim Number, Patient Name, Patient Employer, Date of Injury, etc.). This will allow us to assist you quickly and efficiently. Medical bills are paid within 45 days of receipt. Please make sure that we have an updated W-9 Form with your Tax ID Number and mailing address for payments. We cannot issue payment without an up-to-date W-9 that matches your bill. If you have any questions, please call us at (800) 337-7419. We pay per the applicable Medical Fee Schedule. For more information, click here.