Workers' Compensation Claim Kit – Nebraska

Who will handle your claims?
The Milwaukee Regional Claim Office will handle your Nebraska claims.

Phone: 800-242-4566
Jeanine Ramstack, AVP

Please direct all general correspondence to:

Email:    claimsmail@cfins.com
Fax:        877-622-6911
Mail:      PO Box 14139, Lexington, KY 40512

How to Report Workers’ Compensation Claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report e-mail: crumandforsternol@cfins.com
To report via fax: 1-877-622-6218
To report claims via telephone: 1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms and pamphlets does the employer need to be aware of?

NWCC – Form 1, revised 6/2006 / Employer’s First Report of Injury:
If you report the claim via the Internet or by telephone, you do not need to fill out this form. If you report the claim via fax, complete this form, and fax it to Crum & Forster at the fax number provided above.

Nebraska-FROI-12.11

NWCC – Form 50, revised 3/2013 / Employee’s Choice or Change of Doctor Form:
This form should be given to the injured worker as soon as possible after each injury. The employee has a right to treat with a physician who has treated the employee (or members of his immediate family) in the past. The employer must inform the employee of this right. If the employer does not inform the employee of this right, the restriction does not apply and the employee can choose any physician. If the employee does not have a physician or chooses not to treat with that physician, the employer chooses the physician. Once the employer chooses the physician, that physician can only be changed by agreement of the parties or by order of the Court.

Nebraska-Form 50

Nebraska-Form 50 (Spanish)

What is the Waiting Period for Lost Wages in Nebraska?
The waiting period is 7 days and the retroactive period is six weeks. There is 30 days to accept or deny a claim.

What is the Choice of Physician Rules in Nebraska?
The employer directs care unless employee or family member is an established patient at a doctor, then they can choose to treat with that doctor. See above under Form 50.

Preferred Provider Organization Network (PPO)
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at: https://www-sf.talispoint.com/conduent/cfi/