Refer a Case

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Refer A Case

Coventry Workers’ Comp Services makes the referral process easy by giving you three ways to contact us: telephone, e-mail, or fax. We value your time, so we have designed each of these methods to be as brief and efficient as possible.  Information submitted through the online from will be encrypted using SSL technology.

Refer Online

Refer by Phone

Refer by Fax

Online Case Referral

*Required Fields

*What service does this referral relate to? Select A Service DMEplus Drug Utilization Assessment Field Case Management Independent Medical Examination Legal Nurse Review Life Care Plan Medical Cost Projections Other Pharmacy Peer to Peer (P2P) Physical Medicine Telephonic Case Management Utilization Review Submit

Refer by Phone:  1.866.445.7286

Please call 888.987.2667 for DUA and P2P referrals.  For IME referrals, please call 800.662.2393.  For all other referrals, please call 1.866.445.7286

Refer by Fax:

Click Here for our DUA & P2P Fax Referral Form and send to 866.637.0470

Click Here for IME Referral Form and fax to 877.675.4465

Click Here for our Hospital Discharge Planning Form and fax to 855.398.8240

Click Here for all other Referral Forms and send to 800.396.2457