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<br />5, <br /> <br />~/ß-;? <br /> <br />Exhibit A <br /> <br />CITY OF REDWOOD CITY <br />WORKERS' COMPENSATION PROGRAM <br />PERFORMANCE STANDARDS <br /> <br />The following Claims Administration Performance Standards have been adopted by the City of Redwood City: <br /> <br />1. <br /> <br />Caseload: Each examiner shall have a case load not to exceed 150 open indemnity claims. Each claims <br />assistant shall have a caseload not to exceed 300 open medical only claims. The supervisor shall have a <br />caseload not to exceed 30 open indemnity claims, <br /> <br />2. <br /> <br />Forms: The TPA shall provide all forms necessary for the processing of benefits or claims information <br />including the Employer's Report of Injury, DWC Form 1, return to work slips, vouchers, checks, and other <br />related forms. The cost of providing these forms shall be included within the contract price. <br /> <br />3. <br /> <br />Claim File Set Up and Diary Review: Upon receipt of the Employer's Report of Injury, the TPA will prepare <br />an individual claim file within two (2) working days for each claim. All claim files shall be reviewed at least <br />every forty-five (45) calendar days for active claims and at least every six (6) months for claims that have <br />settled but are 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 shall monitor the <br />diary reviews by printing a "No Activity" report each month to identify any files that have fallen off the diary <br />system, <br /> <br />4. <br /> <br />Employer Contact: The TPA shall request the Employer's Report of Injury form when or if notification of an <br />injury or incident by any source is received first (i.e., Application of Adjudication, notice of legal <br />representation, Doctor's First Report of Injury, etc.). <br /> <br />The TPA will confirm the DWC Form 1 was given to the employee within one (1) working day of knowledge <br />of the injury. If there is no evidence the form was provided, the TPA will provide the form with the initial <br />contact letter to the employee within three (3) business days of receiving the claim. <br /> <br />The TPA shall contact the City within one (1) working day of receipt of notice of a lost time claim by any <br />source. Such contact with the City shall be documented in the computer notepad atter the claim has been <br />created in the system. <br /> <br />When a claim reaches or exceeds one half of the member city's SIR in total incurred value, the TPA shall <br />report to the City, with a copy to the Workers' Compensation Program Manager, every ninety (90) days <br />regarding the status of the claim. Such report shall include the examiner's plan of action for the future <br />handling of the claim. <br /> <br />The examiner will provide on-site file reviews quarterly. <br />scheduled based upon the <br /> <br />Other periodic on-site file reviews will be <br />needs of the' City, <br /> <br />Employee Contact: In all non-litigated, lost time cases, where the employee has not returned to work, <br />telephone or personal contact will be established with the injured employee within two (2) working days of <br /> <br />City of Redwood City WCP Performance Standards <br /> <br />Page 1 of 7 <br /> <br />July 1, 2005 <br />