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Arizona

When an employee is injured on the job, proceed with the following:

  1. Contact a preferred urgent care facility by telephone prior to sending the injured worker.
    • Inform the urgent care that you have an injured worker coming and that Benchmark Administrators is the claims administrator.
  2. If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist the injured worker with any insurance related information that the medical provider may require.
    • If possible, the injured worker must return to your office or job site after seeing the doctor and give you the doctor’s signed return to work slip or disability slip.
  3. If there is a serious injury, notify Benchmark Administrators immediately by telephone at 1-800- 289-4502.
  4. It is necessary that the employer fill out the required Form ICA 04-0101 and notify us immediately. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.

Please send the Form ICA 04–0101 and the medical slip to:

Benchmark Administrators
P.O. Box 140577
Boise, ID 83714
Telephone: (208) 848-2020
Toll free (800) 362- 5198
Fax (208) 853-4076

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891
Customer Service Representatives are on staff 24 hours per day to assist you with reporting a claim. Please have the injured worker’s information available as well as the accident description.