Workers’ Compensation

For California, to find a medical provider near you through the Corvel website, visit this page or download their app for remote access.

Alternatively enter your email address here for access and to create a formal panel of physicians. (Please note an instant automatic reply will be sent to your email address with the login information).

The new CA MPN has been approved by the California Department of Industrial Relations to treat workers injured on the job. Experience has shown that medical outcomes for injured workers can be improved when employees are given a choice of provider(s) in an approved medical provider network.

The CA MPN offers a wide range of benefits, including:

• Earlier return to work – state documented
• Lower medical costs – state documented
• Reduced litigation through internal dispute resolution process
• Access to care within 24 hours
• Limited provider change once enrolled in program
• Limited initial provider selection. Employee risks suspension of compensation benefits if treatment is received from a non-network physician
• No ceiling on control of care, as long as specialty is certified
• Network discounts
• Utilization review is mandated

NOTE: MSIG USA urges all policyholders to participate in our MPN. Utilization of this program provides an excellent opportunity to control workers’ compensation costs, while simultaneously providing quality medical care to your injured workers

How to Get Started Utilizing the MPN

POST at each work site:

• MPN provider panel
• DWC-7, which includes MPN-specific information
• Pre-designation of personal physician form

How to Transfer From One MPN to Another MPN

CA MPN End of Coverage and Implementation Notice must be distributed:

• To all injured workers when changing from an existing MPN to another MPN within 60 days.
• To all employees when changing from an existing MPN to another MPN if more than 60 days have lapsed since ceasing use of a prior MPN.

POST at each work site:

• MPN provider panel
• DWC-7, which includes MPN-specific information
• Pre-designation of personal physician form

MSIG USA will provide the Complete Employee Information notice (0056 Mitsui Sumitomo Ins of America or 2039 Mitsui Sumitomo Ins USA) to the employee once the injury has been reported to MSIG USA. This will serve to educate the employee regarding the MPN and advise the employee how to access the MPN network.

CorVel Corporation may be contacted via:

MPNaccess_Hotline@CorVel.com

The MSIG USA Claims Office in Los Angeles, CA, can assist you with any questions. Please contact one of our representatives at (800) 365-4671. Press 3 to reach the Workers’ Compensation Claim Department.

Please click on the links to the following forms that are available for your use:

Standard Claims and MPN Materials:

• MPN Information Packet: Corvel Information Packet
• Report a Claim: Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
• Telehealth Reference Documents: Virtual Health Care Visits
• Post at Workplace: Notice to Employees – Injuries Caused by Work (DWC 7): 0056 2039
• Provide at Time of Injury: Complete Employee Information Notice – 0056 MSIG USA – 05: (English & Spanish versions)
• Provide at Time of Injury: Complete Employee Information Notice – 2039 MSIG USA – 06: (English & Spanish versions)
• Make Available as Requested: Pre-designation of Personal Physician (English & Spanish versions)

Optional Kaiser MPN Documents

• Report a Claim: Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility
• Post at Workplace: Notice to Employees—Injuries Caused by Work (DWC 7): 2389 2390
• Provide at Time of Injury: Complete Employee Information Notice — 2389 Mitsui Sumitomo Ins of America — 05: (English & Spanish versions)
• Provide at Time of Injury: Complete Employee Information Notice — 2390 Mitsui Sumitomo Ins USA — 06: (English & Spanish versions)
• Make Available as Requested: Pre-designation of Personal Physician (English & Spanish versions)

Dear Policyholder:

Under the Illinois workers’ compensation system, employers can create Preferred Provider Programs (PPP) for workers’ compensation. MSIG USA is offering the availability of a PPP for our policyholders. To assist you in complying with the new regulations, we are providing the PPP Employee Notification Packet.

• If enrolling in the PPP, it is mandatory for the employee to receive a complete copy of the PPP Employee Notification Packet at the time the injury is reported. This packet contains the following:
  • Sample Employee Notification Letter  — mandatory to distribute at the time the injury is reported
  • Sample Employee Acknowledgment Signature Form (recommended) 
  • Sample Opt Out Log
  • Spanish Sample Employee Notification Letter

Find an Illinois PPP Provider

Opt-Out Tracking

If an employee does not want to use the PPP, he or she must notify the employer in writing. Employer/policy holder should keep an active log of opt-out notices received. Please notify MSIG USA if the injured worker has opted out. This is very important to the claims handling process to ensure appropriate care is provided.

At MSIG USA, we believe that timely, early reporting of a claim is the best approach to containing your workers’ compensation costs and assuring your employees receive appropriate medical care. Participation in the PPP will help support medical cost containment and facilitate prompt return to work. If you are interested in participating, please notify MSIG USA.

PPP Program Goals and Objectives:

• To ensure that the injured worker receives quality, cost-effective medical care
• To ensure that medical care is geared toward expedient recovery
• To ensure appropriate steps are taken regarding hospitalization
• To ensure an appropriate discharge plan
• To channel injured employees to the PPP providers and physicians
• To return the employee back to work as quickly as medically feasible

The PPP Helps Injured Workers:

• Receive quality, cost-effective medical care
• Expedite their recovery
• Receive the appropriate hospitalization care
• Ensures an appropriate discharge plan
• Receive access to the network providers
• Ensure a timely return to work

Employer Advantages:

• Manage cost and improve care
• Reduce medical payout
• Provide lifetime medical control of the claim
• Ensure timely recovery and return-to-work outcomes
• Ensure shorter TTD durations (Temporary Total Disability)
• Provide assistance with implementation

Important Announcement — to Our New York State Workers’ Compensation Policy Holders:

The New York State Workers’ Compensation Board Rule 300.37 mandates that a New York employer provide a “Claimant Information Packet” to an injured worker at the time of the injury.

To assist you in complying with this mandatory regulation, you can download the Claimant Information Packet, here.

This requirement applies only to New York State workers’ compensation claims.

Corvel also provides a notice to policy holders: Corvel Notice to Policy Holders

If you have any questions, please contact:

Email: CustomerService@MSIG-NA.com

Texas House Bill 7 was signed into law on June 1, 2005. This law allowed for the implementation of health care networks on or after January 2006.

Since partnering with CorVel Corporation, the CorVel Texas Health Care Network (HCN) has been available to MSIG USA customers. The CorVel HCN offers widespread coverage in the densely populated areas of Texas.

To begin the enrollment process and request assistance, contact our customer service number at (866) 676-6272. To learn more about HCN or for further assistance in the enrollment process, please refer to the following links:

• Employer Posting
• UR Appeals
• Texas CorCare Network Guidelines
• Employee Information Packet PowerPoint
• Texas HCN Presentation for Agents-Employer

2014-01 Texas CorCare Network Requirements (Separate Acknowledgement forms available as well)

• Network Requirements (English/Spanish)
• Acknowledgement Form (English/Spanish)