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d <br />Reporting a Work -Related Injury is Time Sensitive! <br />Call The Hartford's LossConnect immediately to report a claim. <br />1-800-327-3636 <br />Available 24 hours a day, 365 days a year. <br />The Benefits of Timely Loss Reporting: <br />Research has shown that faster loss reporting significantly affects loss costs. The sooner we are notified, the sooner we <br />can investigate the accident and coordinate with you, the injured employee, and the medical team to ensure the fastest <br />possible return to health and work. <br />The Effect of Timely Reporting on Controlling the Cost of Your Loss: <br />Average Loss for Closed Claims <br />(Accident Years 2002-2005 <br />Report Lag in Days <br />Percent Change in Loss Costs <br />Compared to First Week Report <br />Incident Da <br />-6% <br />Week 1 <br />0% <br />Week 2 <br />13% <br />Week 3 or 4 <br />16% <br />1 Month or Later <br />24% <br />Statutory requirements also necessitate the prompt initial reporting of the accident causing <br />injury or death. Failure to comply may result in a fineable offense by the State. <br />Information You'll Need <br />Company Information <br />o Account Number <br />o Location Code (if applicable) <br />o Parent Company (or program name) <br />o Policy Number <br />Worker Information <br />o Name, DOB, Address, Phone <br />o Social Security Number <br />o Age, Gender <br />o Marital Status, Number of Dependants <br />o Hire Date, Years in Current Position <br />o Wage Information <br />Incident Information <br />o Type of injury (burn, cut, etc.)? <br />o Exact body part injured? <br />o What caused the accident? <br />o Any reason to question the injury? <br />o Any witnesses? <br />o Address where injury occurred? <br />o Where was the injured employee treated? (Provide <br />name, address, phone of medical provider.) <br />o When was the accident reported to you and by <br />whom (date, time)? <br />Network Providers <br />A listing of more than 400,000 network providers qualified to treat work -related injuries is available online at <br />www.talisi3oint.com/hartext or by calling our Network Referral Unit at 1-800-327-3636 (select 4 at the prompt). Since <br />network referrals are often impacted by state specific rules, please call to learn how to maximi <br />on behalf of your employees. <br />t <br />y � RenEwm6ArrRov®Br <br />9� �vu.a:+�t ViU U4 <br />Rkk Management Analyst <br />Of <br />Form WC 66 03 84 Printed in U.S.A. <br />