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Vocational Rehabilitation

Important Notice: All qualified rehabilitation providers must put their full UPIN on the billing. The number includes QRP followed by eight numbers.

Brickstreet Insurance takes a proactive team approach to managing work-related injuries. This team approach helps assure that injured workers receive appropriate medical care while a plan is developed to return them to employment as soon and safely as possible.

The injured worker, employer, medical provider, claims adjuster, and return-to-work specialist, medical case manager, and field case manager are all vital members of the Claims Management Team. All team members work together to ensure a successful return-to-work outcome for the injured worker.

One of the most effective tools to bring an injured worker back to work is by developing a return-to-work program. These individualized programs bring injured workers back to the job, either at their regular positions or at modified duties, while they are recovering from their injuries. BrickStreet Insurance provides resources and step-by-step guidelines that outline an effective return-to-work program.

To discuss how Brickstreet Insurance can help you individualize your Return to Work Program, please contact Ruth Gilpin, 304.941.1000 ext. 5610; or, if you know the RTW Specialist assigned to your account, see below:

Angela Simmerman, M.Ed, QRP Coal Team ext. 5300
Tammy Roberts, CDMS, QRP Large Accounts-North ext. 5574
Connie Brammer, QRP Large Accounts-South ext. 5257
Amber J. Rinehart, MA, QRP Standard North ext. 5636
Cindy McCall, MA, LPC, QRP Government ext. 5283
Greg Stark, MA, CRC, QRP Standard Central ext. 5545
Stacy Triplett, QRP Small ext. 5846
Lori H. Hudak, MA, CRC, CDMS, QRP Standard South ext. 5240

Rehabilitation Services Report Forms

Forms that are to be placed in the provider's letterhead need to be unprotected by clicking on Tools, and then select Unprotect from the menu. The document can then be copied and pasted into the provider's letterhead. The final step is to re-protect the document by clicking on Tools, and then selecting Protect from the menu. If these steps are not followed, the forms will not function properly.

BI-ClsrRpt
BI-ClsrRptUse SHIFT+ENTER to open the menu (new window).
7/10/2008 10:52 AMDocument
BI-MCMR
BI-MCMRUse SHIFT+ENTER to open the menu (new window).
7/8/2008 11:03 AMDocument
BI-RTWpr
BI-RTWprUse SHIFT+ENTER to open the menu (new window).
7/8/2008 11:04 AMDocument
BI-TAR
BI - Task Assignment ReportUse SHIFT+ENTER to open the menu (new window).
7/8/2008 11:01 AMDocument
BI-VAR
BI-VARUse SHIFT+ENTER to open the menu (new window).
7/8/2008 11:00 AMDocument
BrickStreet Field Case Management Disclosure Statement
BI-FCMDisclosureStatementUse SHIFT+ENTER to open the menu (new window).
10/25/2007 7:52 AMDocument
BrickStreet Insurance - Physician Statement of Physical Capabilities
BI - PSPCUse SHIFT+ENTER to open the menu (new window).
7/10/2008 10:03 AMDocument
BrickStreet Insurance Job Function Evaluation
BI-Job_Function_EvaluationUse SHIFT+ENTER to open the menu (new window).
7/10/2008 10:03 AMDocument
BrickStreet Qualified Rehabilitation Provider Application
BI-qrpUse SHIFT+ENTER to open the menu (new window).
2/22/2008 1:12 PMDocument
BrickStreet Rehabilitation Plan form
BI-RhbPlnUse SHIFT+ENTER to open the menu (new window).
1/8/2008 12:59 PMDocument
BrickStreet Rehabilitation Statement
BI-RhbStmtUse SHIFT+ENTER to open the menu (new window).
10/25/2007 7:37 AMDocument
BrickStreet Vocational Rehabilitation Agreement
BI-Vocational Rehabilitation AgreementUse SHIFT+ENTER to open the menu (new window).
2/22/2008 1:12 PMDocument
 
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