FSIM’s focus is from “dirt to table,” which includes, growers, shippers, packers, wholesale distributors, custom harvesters, restaurants, grocers, and other selected classes. We offer full workers’ compensation insurance for your employees, making sure they return safely back to work after an accident. In addition to our standard services, the following additional support is provided to our employer clients.
Each account receives personal contact through customer service representatives, loss control consultants, claims management personnel, and medical management services. That personal contact allows us to get the know the people we serve and respond as soon as possible to their questions and needs.
Meadowbrook/Star/Williamsburg/Pro Century Insurance Group
FSIM is the program administrator for your workers’ compensation insurance.
What that means is FSIM works directly with the insurance carrier to:
- receive your first report of injury
- provide nurse case management services as needed
- issue your policy
- handle your monthly payroll reports and payments
- provide safety consultations
- review and monitor your claims
- assist with final audits
Contact email@example.com or call 916-462-6600
Give all of your supervisors/foremen copies of the following
- Refusal of Medical Treatment forms
- Employee Report of Injury (Body Part Chart) form
- DWC1 to have on hand at all times
- MPN Acknowledgement forms (have signed prior to injury)
- 5020 form (employers’ report of injury)
- DWC-1 form
- Body part form with the injury spot circled, initialed and dated by the injured worker
- MPN Acknowledgement Receipt
- Wage earning report (52 weeks preceding the date of injury)
- First doctor’s report (if available)
- Additional Questions form – complete as much as possible
Report all injuries along with completed forms to FSIM:
- Online: www.fsim.us (FSIM Portal log in required)
- Phone: (800) 951-1134
- Fax: (800) 397-7770
- Email: firstname.lastname@example.org
- Employee signs the Refusal of Medical Treatment Form
- Employer gives them a copy of the DWC-1 form with the employer information filled out only (Keep refusal form and copy of DWC-1 form on file just in case you have to send to FSIM)
- DWC-7 form
- MPN Complete Written Notice in English and Spanish
- MPN Implementation Notice Medical Provider Network
- MPN Signature form – This should be signed prior to any injury. Suggestions – at time of hire or at safety meetings.
- Group Signature forms are available. Contact email@example.com to request.
- Go to MPN Provider Search under the Resources and Forms menu; Claims Section on the FSIM Portal. https://portal.fsim.us:4444/Portal/
- Contact the FSIM Medical Management office – (800) 951-1134
- Payroll report and payment is due on the 10th of every month following the month in which the payroll is paid (i.e. February payroll is due on March 10th)
- You must complete a payroll report even if you have zero (0) payroll
Payroll reporting and payment online on the FSIM Portal. www.fsim.us
- Click on My Policies
- Click on blue drop down arrow in front of your active policy
- Click “View Policy”
- Click on the ‘Payroll’ tab at the top of the screen
- Click on the blue banner ‘Report Payroll’
- Payment may be made electronically from the portal (ACH) or you may print your statement and mail the statement with a check
If you have questions or need help on the FSIM Portal contact firstname.lastname@example.org
- Please direct all of your claims inquiries or status updates to your broker first.
- Call the FSIM Medical Management Dept. – (800) 951-1134.
- You may also send your inquiries to: email@example.com
For any class code changes, please contact your broker and advise them of the change. Your broker and FSIM will work together to ensure that the correct class code(s) are on your next payroll report.
Please call or email our customer service staff at: (916) 462-6600 or email firstname.lastname@example.org.