AgdaPkt 2004-09-27 - Laserfiche WebLink

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� i �- �- 20. Subro ag tion: In all cases where a third party is responsible for the injury to the employee, the TPA shall contact the member city indicating they will pursue subrogation unless instructed otherwise by the member city. When subrogation is to be pursued, the third party shall be contacted within ten (10) days of identification, with notification of the member city's right to subrogation and the recovery of certain claim expenses. If the third party is a governmental entity, a claim shall be filed with the governing boazd within six (6) months of the injury or notice of injury. Periodic contact shall be made with the responsible party and/or insurer to provide notification of the amount of the estimated recovery to which the member city will be entitled. If the injured worker brings a civil action against the party responsible for the injury, the TPA shall consult with the member city about the value of the subrogation claim and other considerations. Upon the member city's authori7ation, subrogation counsel shall be assigned to file a Lien or a Complaint in Intervention in the civil action. Whenever practical, the TPA should take advantage of any settlement in a civil action by attempting to settle the workers' compensation claim by means of a Third Party Compromise and Release. If such attempt does not succeed, then every effort should be made through the WCAB to offset claim expenses through a credit against the proceeds from the injured worker's civil action. 21. Vocational Rehabilitation: In accordance with all applicable California laws in place at the date of injury, the TPA shall: A. Determine the Qualified Injured Worker/Non 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 AUTHORITY's self-insured retention shali be reported in accordance with the reporting criteria established by the Locai 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 Pavment: 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. BCJPIA PWCP Performance Standards Page 5 of 7 • February 11, 2004 _ _. _ _. ._,._