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Texas

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

  1. Complete First Report of Injury providing the details of the accident and injury.
  2. Complete Wage statement providing Benchmark Administrators with payroll records documenting 13 weeks of the injured worker’s salary history. If 13 weeks are not available, provide payroll records for the time period the injured worker was employed.
  3. For employers that participate in the Texas HCN, injured workers must select a treating physician from a list of medical care providers in the Prime Health Services network. Use this online provider search tool for help selecting a physician. Once a physician has been selected, the injured worker is to provide the contact information of the physician to Benchmark Administrators immediately.
  4. For employers NOT participating in the Texas HCN, injured workers may treat with a physician of their own choosing. Once a physician has been selected, the injured worker is to provide the contact information of the physician to Benchmark Administrators immediately.
  5. Advise the injured worker they must return to your office or job site after receiving medical care and provide the doctor’s signed return to work slip or documentation of medical disability.
  6. Please forward the return to work/disability slip from the doctor to Benchmark Administrators as soon as possible.
  7. 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.

Required State Forms

Additional Forms

Texas Health Care Network Resources

Correspondence & Prescription Billing

Benchmark Administrators
PO Box 46350
Las Vegas, NV 89114
Telephone: (321) 594-7222
Toll Free: (800) 362-5198
Fax: (352) 240-1203

Medical Billing

Medical Bills Can Be Mailed To:

P.O. Box 14365
Lexington, KY 40512

Process medical bills online by signing up with E-Billing Benefits

Western Integrated Care, on behalf of Benchmark Administrators, Payer ID is LV191.

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891

Customer Service Representatives are on call 24 hours per day to assist you. Please have the injured worker's information available as well as the accident description.