CLAIMS REPORTING

Community First's claims handling is provided by Gallagher Bassett Services, Inc. , a Third Party Administrator, with offices nationwide. With the strength of over 40 years of claims management experience, they offer centralized administration, heightened claim responsiveness, quality control programs, and consistent, nationwide performance standards to ensure that your money, energy, and resources are spent wisely – not expended wastefully. Gallagher Bassett also does all that they can to make sure that every claim is settled fairly and quickly.

Reporting claims can be completed in two ways:
By Fax: 800-953-8414
By Telephone: (800) 501-8408

Forms to complete when an injury occurs:

1. To report the claim by FAX, please complete eFAX Claim Report Form-California or eFAX Claim Report Form-all states and using eFAX Cover Sheet fax to 800-748-6159. You will receive a confirmation by fax.
2. To report the claim by phone, please complete Employer's Report-California 5020 so you will have all the information readily available and call 800-501-8408 to report the claim.
3. Please remember to provide the injured worker an Employee's Claim of Workers' Compensation Benefits (DWC-1), for their completion. This form must be provided to the injured worker within 24 hours of employer's knowledge that an injury has occurred.

Correspondence after the claim has been reported:

• The completed DWC-1 should be transmitted by FAX to Gallagher Bassett at 866-889-5178.
• Medical providers should send their bills and reports to:
  Gallagher Bassett Services, Inc.
  P.O. Box 23812
  Tucson, AZ 85734
• Any other correspondence should be sent to the Gallagher Basset Claims Office at P.O. Box 610, Roseville, CA 95678. Their phone number is 866-456-8402.