AgdaPkt 2005-06-13 - Laserfiche WebLink

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26. 27. ~/ð-/;3 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 Califomia laws in place at the date of injury, the TPA shall: A. Detennine 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 infonnation. 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 CPEIA excess joint powers authority 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 Califomia law. The City will be provided a listing of any administrative penalties paid during the quarter, which were the responsibility of the TPA, and a check from the TPA payable to the City for reimbursement. Case Closure: The supervisor must review all Medical Only claims open beyond ninety (90) days from the date of entry by the TPA, 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 plõced on the claim(s). All indemnity cases where pennanent 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 pennanent disability is an issue will remain open for two (2) years from the last payment of benefit and then closed within sixty (60) days of that date. The TPA will monitor stipulated cases with future medical provisions. Reserves for future medical will be reviewed semi-annually and adjusted according to use. Status RepOrts: Special claim status reports requested by the City outside the regular 9O-day status reports shall be provided by the TPA to the respective city within ten (10) business days. Verbal status reports requested by the City shall be provided by the TPA to the City within two (2) business days, Special City of Redwood City WCP Performance Standards Page 5 of 7 July 1, 2005