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Agmt05 Claims Management Inc
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Agmt05 Claims Management Inc
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Last modified
4/24/2007 9:04:37 AM
Creation date
7/22/2005 8:55:38 AM
Metadata
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Template:
Agreement
Contractor Name
Claims Management Inc
PROJECT NAME
third party administrator
RMP File Number
304
Date
7/20/2005
MO Ref
05-105
Box
6360
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<br />20. <br /> <br />The TPA shall determine the nature and øx::e-:'1t of p\~ni.:;;ì ,jilt disability and arrange for an informal disability <br />rating whenever possible to avoid Workers' Compensation Appeals Board litigation. <br /> <br />All permanent disability benefit notices shall be sent to the employee as required by the Labor Code. <br /> <br />18. <br /> <br />Litiqated Cases: The TPA shall promptly initiate investigation of issues identified as material to potential <br />litigation. The member city shall be alerted to the need for an outside investigation as soon as possible and <br />the examiner shall appoint an investigator who is acceptable to the member city. The member city shall be <br />kept informed on the scope and results of all investigations. . <br /> <br />When defense counsel is not necessary, the TPA shall work closely with the applicant's attorney in informal <br />disposition of litigated cases. <br /> <br />The member city shall be alerted to the need for an outside counsel as soon as possible and the examiner <br />shall appoint an attomey who is acceptable to the member city. <br /> <br />Settlement proposals directed to the member citY shall be forwarded by the TPA or defense counsel in a <br />concise and clear written form with a reason(s) for such recommendation. <br /> <br />All preparation for a trial shall involve the member city so that all material evidence and witnesses are <br />utilized to obtain a favorable result for the defense. <br /> <br />The supervisor or the examiner shall attend Workers' Compensation Appeals Board hearings, rehabilitation <br />hearings, meetings with defense counsel, and meetings with member cities' staff, departments, and <br />employee groups as necessary and as requested to do so. <br /> <br />19. <br /> <br />Settlements: The TPA shall obtain the City's written authorization on all settlement or stipulations within the <br />City's retained limit. All requests for settlement authority shall include a written claim summary, current <br />financial information, estimate of permanent disability, and the defense counsel's comments and <br />recommendations, if any. <br /> <br />Subroqation: In all cases where a third party is responsible for the injury to the employee, the TPA shall <br />contact the member city indicating they will pursue subrogation unless instructed otherwise by the member <br />city. When subrogation is to be pursued, the third party shall be contacted within ten (10) days of identification, <br />with notification of the member city's right to subrogation and the recovery of certain claim expenses. If the <br />third party is a govemmental entity, a claim shall be filed with the goveming board within six (6) months of the <br />injury or notice of injury. <br /> <br />Periodic contact shall be made with the responsible party and/or insurer to provide notification of the <br />amount of the estimated recovery to which the member city will be entitled. <br /> <br />If the injured worker brings a civil action against the party responsible for the injury, the TPA shall consult <br />with the member city about the value of the subrogation claim and other considerations. Upon the member <br />city's authorization, subrogation counsel shall be assigned to file a Lien or a Complaint in Intervention in the <br />civil action. <br /> <br />City of Redwood City WCP Performance Standards <br /> <br />Page40f7 <br /> <br />July 1, 2005 <br /> <br />r - <br />
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