CLM-59898

SMS to Marcus T. Ellison (demo-routed)

Post-call SMS summary promised on the call, within the hour, per playbook.

Marcus — thanks for the call. Quick recap: claim CLM-59898, adjuster Sam Chen at Larkspur Mutual. Medical treatment i…

Set claim field "represented_flag"

Marcus confirmed on the call that he has not spoken to or hired an attorney.

→ false

Set claim field "preferred_contact_channel"

Marcus confirmed on the call that SMS is the best way to reach him for updates and short questions.

→ sms

Set claim field "three_point_contact_ee_complete_at"

Employee leg of three-point contact closed on the connected call at 12:46 PT.

→ 2026-09-04T19:46:52.745Z

Outbound call to Marcus T. Ellison (demo-routed)

Marcus texted asking for a callback in 15 minutes; schedule the call for that window so it fires at the time he named.

Complete the employee leg of three-point contact with Marcus Ellison. Confirm identity, walk through what we already have from the intake, and ask only about…

SMS to Marcus T. Ellison (demo-routed)

Acknowledge his text so he knows the callback is booked for the window he named.

Got it — will call you in 15. Talk soon.

Scheduled outbound call to Marcus T. Ellison (Employee)

Marcus texted asking for a callback in 15 minutes; schedule the call for that window so it fires at the time he named.

Complete the employee leg of three-point contact with Marcus Ellison. Confirm identity, walk through what we already have from the intake, and ask only about…

Send email — Records request — Ellison, Marcus — DOI 3/2/26 — CLM-59898

Day-2 provider records request naming the five specific items needed from the 5021, referencing the standing §5402(c) authorization inside MPN 2519.

Send email — Re: New WC claim — Ellison, Marcus — CLM-59898 — employer follow-up

Day-2 substantive three-point-contact email to the employer: wage basis (field 39 gap), modified duty specifics, Barragán as witness of record, MPN acknowledgment.

SMS to Marcus T. Ellison (demo-routed)

Voicemail was left; per playbook, immediately SMS to ask for a good callback time so the employee three-point contact leg can close.

Hi Marcus — Jennie from Larkspur Mutual, on your work comp claim (CLM-59898) from the shoulder injury on 3/2. Just le…

Outbound call to Marcus T. Ellison (demo-routed)

Day-1 employee leg of three-point contact runs in parallel with Priya's acknowledgment; Marcus's number is on his party record from the DWC-1.

Complete the employee leg of three-point contact with Marcus Ellison on the same day the claim opens. Confirm identity, walk through what we already have fro…

Email to Priya Raman: Re: New WC claim — Ellison, Marcus — DOI 3/2/26 — right shoulder (demo-routed)

Day-1 acknowledgment: confirms setup, posts §5402(c), answers Priya's payroll question, lists attachments received, previews Day-2. No wage/modified-duty asks yet.

Priya, We have your report. The claim is set up as CLM-59898 under policy LM-WC-3308714-26. Sam Chen is the adjuster of record. As of today, up to $10,000 in medical treatment inside the Larkspur…

Set claim field "mpn_id"

Larkspur Mutual MPN 2519 from policy extended fields.

→ 2519

Set claim field "wage_basis_flag"

5020 field 39 (other payments incl. overtime) is blank on a warehouse order-selector class that routinely works overtime; certified 52-week statement needed per LC §4453.

→ true

Set claim field "modified_duty_status"

Employer has him on light duty but no 5021 restrictions in file yet — verbal-only until written restrictions arrive.

→ offered_verbal_only

Set claim field "modified_duty_wage_continuation"

Per 5020 — drives that no TD is currently owed.

→ full wage, same 40 hours, same shift

Set claim field "scheduled_hours_per_week"

5020 field 37 / job description.

→ 40

Set claim field "base_hourly_rate"

5020 field 38.

→ 26.5

Set claim field "jurisdiction_state"

CA WC.

→ CA

Set claim field "employer_fein"

FEIN per incident report and job description; 5020 shows an inconsistent number (914-8827-3) — using the two-doc corroborated value.

→ 87-4419026

Set claim field "class_code"

Wholesale grocery per 5020 and job description; matches policy.

→ 8018

Set claim field "workplace_address"

Warehouse workplace per all docs.

→ 1450 Almond Terrace Drive, Modesto, CA 95358

Set claim field "time_of_injury"

DWC-1 and supervisor incident report both show 2:10 p.m. (5020 has an obvious typo of 5:00 AM); align to the two corroborating documents.

→ 2:10 PM

Set claim field "mechanism_narrative"

Most specific narrative from the 5020.

→ Employee was pulling a 42 lb case toward him off the second rack shelf when the case caught on the rack lip. His right arm was pulled up and back, causing a pop and immediate pain in the right shoulder.

Set claim field "cause_of_loss_wc"

Mechanism established across all intake docs.

→ overexertion_lifting

Set claim field "nature_of_injury"

Per 5020.

→ strain / tear

Set claim field "body_part_side"

Right side per all source docs.

→ right

Set claim field "body_part"

Primary body part per 5020/5021 workflow.

→ shoulder

Set claim field "date_reported_to_employer"

Anchors the LC §5402(b) 90-day clock.

→ 2026-03-02

Set claim field "date_of_injury"

Capture DOI from 5020/DWC-1/incident report all in agreement.

→ 2026-03-02

Match policy "LM-WC-3308714-26"

Link the WC policy extracted from the Form 5020 header so the submission can convert.