Nationwide

Workers' Compensation Toolkit

This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.

Your state administers Workers' Compensation insurance in this state.

Please contact your state with any questions:

http://www.lni.wa.gov/ClaimsIns

Below are a few additional tools to help you manage your workers' compensation claim:

Locate medical providers - Are you an employer or injured worker looking for doctors, hospitals or pharmacies? We can help you find local medical professionals.

First Fill program - The First Fill program allows one-time prescription processing before a workers' compensation claim is established, resulting in no out-of-pocket cost for the injured worker. Ask your claims representative for more details.

EBill submission for Medical Providers through Jopari - Nationwide Insurance is registered with Jopari Solutions, Inc. for eBill submission. Call 800-630-3060 or email support@jopari.com for assistance.

EBill submission for Medical Providers through WorkCompEDI - Nationwide Insurance is registered with WorkCompEDI, Inc. for eBill submission. Call 800-267-6909 to speak to Debbie Hoffer (x1311) or Frank Giampetruzzi (x1318), or email info@workcompedi.com for assistance.

NOTE: If you experience difficulty opening/accessing the PDF's using the links below:

Open to access the documents

Washington Compliance Information:

Posting Requirements
Reporting Of Claim By Employer
Penalties for Late Reporting
Physician Selection

Posters and Publications

POSTER - Notice to Employees Required

POSTER - Job Safety and Health Law Required

POSTER - Your Rights as a Worker in Washington State Required

POSTER - Self-Insurance Poster (English and Spanish) Required

Third Party Election Form / Brochure- Injured by a Third Party?

NOTICE - Workers" Compensation Filing Information Required

Forms

First Report of Injury

Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

This service uses a proprietary system to pre-fill certain claims office and insurance company data on some forms. This may prompt a request by your Adobe Reader program to "trust" the source of the files. Please designate this as a trusted source in order for that information to be pre-filled for you.

The documents in this system use Adobe Reader to view PDF files. If you do not have Adobe Reader, you may download the latest version here for free. Download Adobe Reader Here