AgdaPkt 2004-09-27 - Laserfiche WebLink

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�. � �� 5. Employee Contact: In all non-litigated, lost time cases, where the employee has not returned to work, telephone or personal contact will be established with the injured employee within two (2) working days of receipt of notice of claim. Such contact will continue as often as necessary, but at least monthly until the employee returns to work. Such contact with the employee shall be documented in the computer notepad. Return phone calls to employees will be accomplished within one (1) working day. All correspondence from employees will be responded to within five (5) days of receipt. 6. Reserves: Reserves shall be established based upon the ultimate probable cost of each claim. All reserve categories shall be reviewed on a regular basis but at least every ninety (90) days. Such review shall be indicated in the computer notepad. The examiner shall utilize a reserve worksheet which has been approved by the Local Agency Workers' Compensation Excess Joint Powers Authority (LAWCX) pursuant to that JPA's Resolution Establishing a Claims Management Policy. Any changes to reserves shall include an explanation for the change. A claims assistant shall have authority to establish reserves not to exceed $3,000. An examiner shall have authority to establish reserves not to exceed $50,000. A senior examiner shall have authority to establish reserves not to exceed $75,000. The supervisor shall have authority to establish reserves not to exceed $150,000. A director, vice president, or president of the TPA shall review and approve all reserves in excess of $150,000. 7. Medical Administration: The TPA shall select a panel of general practitioners, specialists, hospitals, and emergency treatment facilities to which injured employees should be referred, as approved by the AUTHORITY, and the TPA shall regularly review and update the panel. The physician's office will be contacted within five (5) days of notice of all indemnity claims. Such contact will continue as needed during the continuation of temporary disability to assure that treatment is related to a compensable injury or illness. The TPA shall maintain contact with treating physicians to ensure employees receive proper medical treatment and are returned to full or modified employment at the earliest possible date. The TPA shall maintain direct contact with medical service providers to ensure their reports are received in a timely manner. The TPA shall arrange medical evaluations when needed, reasonable, and/or requested in compliance with the cunent Labor Code. The TPA shall ensure that medical bills are reduced to the recommended rates established by the Administrative Director of Workers' Compensation. The use of a service contractor is acceptable provided the AUTHORITY's approval is first obtained. The AUTHORITY shall pay for the use and benefits of the services provided. BCJPIA PWCP Performance Standards Page 2 of 7 February 11, 2004