How to Complete the Connecticut AIG Workers' Compensation Doctor's Claim Form

What Is the AIG Doctor's Claim Form?

The AIG Workers' Compensation Doctor's Claim Form is a standardized document used by physicians in Connecticut to submit medical evidence for a worker's injury claim. The form collects patient details, medical findings, treatment plans, and cost estimates that the insurer uses to evaluate benefit eligibility.

Who Must Use It?

Any licensed medical professional who has treated a Connecticut worker injured on the job and wishes to submit a claim to AIG Workers' Compensation must complete this form. This includes primary care physicians, specialists, and physical therapists who are part of the AIG network.

Key Sections of the Form

Patient & Employer Information

This section captures the worker's full name, date of birth, job title, and employer contact details. Accurate employer data is critical because the insurer must verify employment status before proceeding.

Injury Description & Medical History

Here you describe the injury, its onset date, and any prior conditions that might affect treatment. Provide a concise narrative and attach any diagnostic reports.

Treatment Plan & Prognosis

Detail the recommended medical interventions, expected recovery timeline, and any restrictions. Include a clear statement of the medical necessity for each treatment.

Cost Estimate & Billing Information

List all expected charges, including office visits, procedures, medications, and supplies. Attach itemized bills if available. This helps AIG assess the financial aspect of the claim.

Signature & Certification

Physicians must sign and date the form, certifying that all information is accurate and that the treatment plan complies with state regulations.

How to Complete the Form

Step 1: Gather Patient Records

Collect all relevant medical records, imaging results, and prior physician notes before starting the form. Having everything on hand reduces the risk of missing data.

Step 2: Enter Accurate Personal Details

Double‑check spelling of the worker's name, employer's address, and phone numbers. Even minor typos can delay processing.

Step 3: Describe the Injury Clearly

Use objective language. For example, instead of "severe pain," state "pain rated 8/10 on the numeric pain scale" and note any functional limitations.

Step 4: Outline the Treatment Plan

List each appointment, procedure, and medication. Specify the frequency (e.g., "twice weekly physical therapy") and the total number of sessions expected.

Step 5: Provide a Detailed Cost Estimate

Attach itemized invoices when possible. If only a summary is available, include a brief explanation of each line item.

Step 6: Sign and Submit

Sign the form, date it, and send it to the address or electronic portal indicated on the back of the document. Keep a copy for your records.

Common Pitfalls to Avoid

• Leaving the employer contact blank – AIG will not process the claim without it.
• Using vague injury descriptions – Precise details speed review.
• Missing cost breakdowns – Incomplete estimates can lead to denial or delays.
• Failing to attach required diagnostic reports – These are often requested during the review.

What Happens After Submission?

AIG will assign a claims adjuster who reviews the form. The adjuster may request additional documentation or schedule a medical review. Once approved, the insurer pays the covered medical expenses directly to the treating physician.

Helpful Resources

Connecticut Department of Labor: https://www.ctdol.state.ct.us/

AIG Workers' Compensation: https://www.aig.com/

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