Agmt04 Claims Management BCJPIA - Laserfiche WebLink

Browse Search

21. Vocational Rehabilitation: In accordance with all applicable California laws in place at the date of injury, the TP A shall: A. Determine the Qualified Injured WorkerlNon Qualified Injured Worker status; B. Advise the injured worker of his/her right to rehabilitation benefits; C. Provide appropriate vocational rehabilitation benefits; D. Control rehabilitation costs; and E. Attempt to secure the prompt conclusion of vocational rehabilitation benefits. 22. Claim Reconciliation: All claim files shall be reconciled to ensure all, indemnity payments have been made correctly. The reconciliation should verify that payments were in the correct amount and from the correct claim file. The physical file should be verified with the computer information. All open claim files shall be reconciled at the time of a request for settlement authorization and at the time of submission for closure. Proof of the reconciliation should remain in the claim file. 23. Excess Insurance: Cases that have the potential to exceed the City's self-insured retention shall be reported in accordance with the reporting criteria established by the Local Agency Workers' Compensation Excess Joint Powers Authority (LAWCX) and any other excess insurance policies. All cases that meet the established reporting criteria are to be reported within five (5) days of the day on which it is known the criterion is met. 24. Award Payment: Payments on awards, computations, or Compromise and Release agreements will be issued within ten (10) days, or sooner if necessary to ensure payment within twenty (20) days of the WCAB approval date, following receipt of the appropriate document. 25. Penalties: Late payment of all benefits must include the self-imposed penalty in accordance with California law. The City will be provided a listing of any administrative penalties paid during the quarter, which were the responsibility of the TP A, and a check from the TP A payable to the City for reimbursement. 26. Case Closure: The supervisor must review all Medical Only claims open beyond ninety (90) days from the date of entry by the TP A, for potential closure or conversion to Indemnity claim status. Claims with $3,000 (three thousand dollars) or more paid to date and any claim open beyond one hundred eighty days from date of entry must be converted to Indemnity status and a reasonable, precautionary indemnity reserve placed on the claim(s). All indemnity cases where permanent disability is not an issue will be closed within sixty (60) days of the final financial transaction or final correspondence to the injured worker as required by law. All indemnity claims where permanent disability is an issue will remain open for two (2) years ftom the last payment of benefit and then closed within sixty (60) days of that date. The TP A will monitor stipulated cases with future medical provisions. Reserves for future medical will be reviewed semi-annually and adjusted according to use. City of Redwood City - Performance Standards Page 6 of8 July 1, 2004 --. ..