How your claim is evaluated
An overview of how you can help your claim go faster and smoother, and the tools available for you, like MyClaim. Because our main job is to help you recover and get back to work, and the more information we have, the better.
We begin evaluating a claim as soon as we receive an 801 (Report of Job Injury) or 827 (Attending Physician) form.
Under state law, SAIF has 60 days from the date your claim was reported to make a decision about it. We will notify you and your employer in writing when the claim has been accepted (and what the accepted conditions are) or denied. A SAIF claims staff member will be assigned immediately to evaluate your claim.
Claim evaluation timeline
Why does it take up to 60 days? It usually doesn't, but during that time your adjuster:
- Will work with you and your attending physician to make sure you get the treatment you need.
- Will gather information about the accident. Having the right information helps make sure you get the benefits you deserve.
- Might call you to get details about the accident. These calls are typically recorded to make sure we have accurate information or to document our conversation. If we determine that more information is needed, we might send a SAIF employee to the worksite.
- Will send you plenty of information, including a comprehensive claim guide.
- Explain what happens if you do not participate in medical treatment, submit required forms, or tell us about changes in your status.
- Might ask you to attend an independent medical exam (IME).
Remember to have your claim number with you when you complete any forms, see a medical provider, go to a pharmacy, or call SAIF.
All claims are in "deferred" status until a decision is made by SAIF. Read more about what your claim status means.
And remember: The status of your claim may change as you progress through your recovery.
Your role in the process
The most important thing you can do—besides attend your medical appointments and follow your doctor's treatmemt recommendations—is to stay in touch with your adjuster frequently and be an active participant in the claim process. Complete and return forms to us as soon as possible. And keep your employer updated.
Communicate with your adjuster as often as necessary—not just because your adjuster can help you, but because your benefits can be suspended if you don't respond to requests for information or attend medical appointments.
Our injured worker secure site, MyClaim, is an excellent way to stay on top of your claim and be your own advocate. It has claim data, payment history, letters from SAIF, and other information specific to your claim. This site was created for you, so register today, if you haven't already, and log in regularly.
If your claim is accepted, you'll receive a lot of information from us by mail. All of it is important-like instructions for the pharmacy program-so please read it carefully.
As part of the claim evaluation, you might be asked to complete a form, such as:
Returning to work
If your doctor says you cannot return to your regular job right away due to restrictions, your doctor may authorize modified (also called "transitional") work first.
Release to modified work
If your doctor authorizes you for modified work, send your adjuster and your employer a copy of the work release as soon as possible. We have resources, like our return-to-work consultants, who will work with your employer if needed to find modified work for you based on what your doctor says you are capable of doing. Our return-to-work consultants also can help your employer access benefits like the Employer-at-Injury Program.
If you are restricted from performing your regular work, have your doctor give you an updated work release with specific restrictions at every appointment. If needed, you can have your doctor complete the work release form. Provide a copy of your work release to your employer and adjuster, and keep a copy for your records.
Modified work can be a job completely different from your regular position or it can simply be a modified version of the regular job you were performing at the time of your injury.
If your employer doesn't have modified work available, you may remain eligible for time-loss benefits.
Vocational assistance and return-to-work programs also are available if your injury results in permanent work restrictions. See the Claim closure page for more, or just ask your adjuster.