Laserfiche WebLink
(��I-�.y <br /> CITY OF REDWOOD CITY <br /> WORKERS' COMPENSATION PROGRAM <br /> PERFORMANCE STANDARDS <br /> The following Claims Administration Performance Standards have been adopted by the <br /> City of Redwood City and the BCJPIA: <br /> 1. Caseload: Each examiner shall have a caseload not to exceed 175 open indemnity <br /> claims. Each claims assistant shall have a caseload not to exceed 300 open medical only <br /> claims. The supervisor shall have a caseload not to exceed 30 open indemnity claims. <br /> 2. Forms: The TPA shall provide all forms necessary for the processing of benefits <br /> or claims information including the Employer's Report of Injury, DWC Form 1, return to <br /> work slips, vouchers, checks, and other related fonns. The cost of providing these forms <br /> shall be included within the contract price. <br /> 3. Claim File Set Up and Diarv Review: Upon receipt of the Employer's Report of <br /> Injury, the TPA will prepare an individual claim file within two (2) working days for <br /> each claim. All claim files shall be reviewed at least every forty-five (45) calendar days <br /> for active claims and at least every six (6) months for claims that have settled but are <br /> open for the employee's future medical care. The examiner shall distinguish the regular <br /> diary review from routine file documentation in the computer notepad. The supervisor <br /> shall monitor the diary reviews by printing a"No Activity" report each month to identify <br /> any files that have fallen offthe diary system. <br /> 4. Emplover Contact: The TPA shall request the Employer's Report of Injury form <br /> when or if notification of an injury or incident by any source is received first (i.e., <br /> Application of Adjudication, notice of legal representation, Doctor's First Report of <br /> Injury, etc.). <br /> The TPA will confirm the DWC Form 1 was given to the employee within one (1) <br /> working day of knowledge of the injury. If there is no evidence the form was provided, <br /> the TPA will provide the form with the initial contact letter to the employee within three <br /> (3) business days of receiving the claim. <br /> The TPA shall contact the member city within one (1) working day of receipt of notice of <br /> a lost time claim by any source. Such contact with the member city shall be documented <br /> in the computer notepad after the claim has been created in the system. <br /> When a claim reaches or exceeds one half of the member city's SIR in total incuned <br /> value, the TPA shall report to the member city, with a copy to the Workers' <br /> Compensation Program Manager, every ninety (90) days regarding the status of the <br /> Ciry of Redwood City - Perfmmance Standards Page 1 of 8 ]uly 1, 2004 <br />