Tokio Marine America’s (TMA) nationwide Workers' Compensation Claims Specialists and Managers have extensive claims handling experience. From new loss receipt to investigation, medical treatment coordination, timely reserves, prompt benefit payments, and claim resolution - you benefit from the expertise of jurisdictionally licensed professionals managing your claims.
Follow the Steps Below to Report a Claim
Three options are available to report your workers' compensation injuries:
We recommend either of the first two options since these methods increase the timeliness and accuracy of reporting new workers' compensation claims. Both programs are offered through our claim intake partner ACTEC. These methods replace the manual process of completing and filing the employer's report of injury form.
Information needed when reporting your claim can be found on the Employer's First Report of Injury.
Employers: please provide a location code (if applicable) to ACTEC so we can classify your losses accurately.
Claim Set-up Process
Once your claim is reported, the designated Tokio Marine claims office automatically receives your claim from ACTEC.
Tokio Marine will send you an acknowledgment letter when the claim is established in our system.
Cost Containment Programs
Preventing escalating medical and disability costs requires early intervention through a series of cost-containment strategies, including a comprehensive Managed Care Program.
Tokio Marine cost containment programs include:
- Medical Bill Review: Control costs by identifying overutilization, overcharging, miscoding, and other abuses and paying only for medically necessary treatment.
- Utilization Review: Pre-certification of medical treatment to ensure all treatment requests are medically necessary.
- PPO Networks: Quickly locate quality medical care with industrial clinics, hospitals, specialists, diagnostic facilities, durable medical equipment, as well as physical and psychological therapists.
- Pharmacy Savings Programs: Lower prescription costs by utilizing network pharmacies, control overutilization, and simplify filling prescriptions with no out-of-pocket expense.
- Managed Care Organization Programs (MCO): Provide maximum cost savings by utilizing a certified network of quality medical providers. MCO savings are achieved by extending medical control and channeling medical care to quality network providers. Each state has its own unique requirements for implementation. See below to learn more about Tokio Marine's MCO offerings.
Managed Care Organization Programs
To help control the rising cost of workers' compensation, states have passed legislation allowing employers to utilize Managed Care Organizations (MCO).
A Managed Care Organization (MCO) is a network of licensed healthcare professionals committed to providing quality medical treatment at a discounted price.
Tokio Marine has MCOs certified in the states of California and Texas.
Tokio Marine continually evaluates new legislation signed into law to ensure we are in compliance and offer the latest in managed care services for our customers.
Learn more about Tokio Marine's Managed Care Organizations available in your state:
For assistance with Managed Care enrollment, please email managedcare@tmamerica.com.
