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Employer's Report of Occupational Injury/Illness (5020)

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California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death.

Claims And Medical Management

Medical Vendors

When submitting a corrected claim or reconsideration, include the following information:

  • The bill and/or cover letter labeled “RECONSIDERATION”;
  • A copy of the EOR and any supporting documentation.

Mail to:
Preferred Employers Insurance Company,
PO Box 14817,
Lexington, KY 40512

 

Med Bill Lookup Tool

Medical providers can check bill status using our easy MedBill Lookup Tool. There is no login required and you can obtain date of receipt, paid amounts, check numbers and request an EOB:  https://peiportal.peiwc.com/wps/portal/MBRBillLookup/peiwc

 

Medical Bill Review is handled by Berkley Medical Management Solutions.  For questions, contact the Medical Bill Review team at 800-732-0153.

 

Preferred Employers Insurance offers electronic bill submission via Jopari, electronic payor ID is J1496.  Payment options via Jopari can be selected by calling 800-630-3060 or visit https://www.jopari.com/jopari-ebill/

 

Comprehensive Claims Management

Our MPN doctors and nurses are specifically trained to handle workplace injuries and illnesses.  As a policyholder of Preferred Employers, you’ll have peace of mind knowing that your injured workers are handled by experts in occupational medicine.

 

Timely Delivery of Benefits

We encourage and facilitate early communication between employers, injured workers and the doctors immediately following a work injury.  Experienced technicians are trained to ensure timely delivery of benefits.

 

Prompt Reporting Matters

Prompt reporting of all work related injuries or illnesses is key to getting injured workers the care they need fast.  The quicker a claim is called in, the more positive an impact all parties will experience on loss time from work and ultimate claim cost.

 

Medical Provider Network (MPN)

Our team works closely with injured workers to match them with an MPN physician that is conveniently located near their place of residence.  All of our medical providers are directly contracted with our Medical Provider Network (Preferred Select MPN).  This ensures they will provide quality care while at the same time, help control overall medical expenses.

Medical Access Assistance (MAA) is available toll free at (888) 799-6477, 7 am – 8pm (Pacific) Monday through Saturday to help injured employees find available MPN physicians or to help with scheduling medical appointments.

 

Fraud Fighters Are Us!

We thoroughly investigate all suspected workers’ comp insurance fraud.

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PEG Wage Statement Form

< Click Here To Go To Our Online Form

California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or illness, the employer must file within five days of knowledge an amended report indicating death.