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<br />v. <br /> <br />CLAIMS ADMINISTRATION <br /> <br />CMI shall provide the following workers' compensation claims management for the Client: <br /> <br />A. Review on behalf of Client all reports of injury as defined by Labor Code Section 3208 and 3208.1, and <br />make contact with injured employee within 24 hours notice of lost time injury is received. <br /> <br />B. On each reported injury, determine those benefits, if any that should be paid or rendered under the <br />Califomia Workers' Compensation Laws. Client is responsible for completion of Employe~s Report of <br />Injury within five (5) days from the date of knowledge. Client will be responsible for any penalties or <br />assessments if claim is not reported in five (5) days from date of knowledge. <br /> <br />C. Establish and maintain an orderly claims file on each reported claim. Each file shall be available to Client <br />for inspection, with or without prior notice to adjusting firm. <br /> <br />D. Maintain an estimate of the total cost of all reasonably foreseeable benefits and related expenses on each <br />case. Each cost shall be recorded separately in the following categories: <br /> <br />1. <br />2. <br />3. <br />4. <br /> <br />Medical <br />Indemnity <br />Allocated <br />Rehabilitation <br /> <br />E. Pay on behalf of Client from Client funds, those sums that should reasonably be paid under the Califomia <br />Workers' Compensation Laws for each reported claim. Any settlement in excess of the mutually agreed <br />limit set forth in Client's Performance Standards, must be first approved by the Client. <br /> <br />F. Refer to attomeys selected by the Client, cases where an employee of the Client files an Application with <br />the Califomia Workers' Compensation Appeals Board. It is understood that even when an Application has <br />been filed, a substantial effort will be made by CMI to settle the claim file without assigning it to legal <br />counsel. <br /> <br />G. Select medical doctors, psychiatrists, psychologists, medical managers, etc., schedule medical <br />appointments, and other services, as is reasonably necessary in the management of workers' <br />compensation cases.. <br /> <br />H. Proceed against responsible persons, agencies and/or their agent in subrogation actions in order to <br />recover losses suffered by Client. <br /> <br />I. <br /> <br />The following fees will be billed to the file under the "allocated loss expenses" which are defined to include <br />all fees for attomeys, witnesses, court reporters, photocopies, process servers, independent investigators, <br />claims index bureau filing fees, any court or Workers' Compensation Appeals Board costs or filing fees, <br />fees for depositions, surveillance, or the necessary engagement of personnel, independent of CMI in the <br />handling of any claim subject to the proposed Agreement. <br /> <br />J. Provide a monthly check register of all financial transactions. <br /> <br />K. Provide a computerized loss analysis and summary each month covering activity of claims reported to <br />CMI to include cumulative loss information to date. <br /> <br />Redwood City 2004-2005\word\cmi\contracts\lk <br /> <br />Page 2 of6 <br /> <br />OS/24/05 <br /> <br />r - <br />