Agmt05 Claims Management Inc - Laserfiche WebLink

Browse Search

receipt of notice of claim. Such contact will continue as often as necessary, but at least monthly until the employee returns to work. Such contact with thp ::mployce shall be documented in the computer notepad. Retum phone calls to employees will be accomplished within one (1) working day. All correspondence from employees will be responded to within five (5) days of receipt. 6. Reserves: Reserves shall be established based upon the ultimate probable cost of each claim. All reserve categories shall be reviewed on a regular basis but at least every ninety (90) days. Such review shall be indicated in the computer notepad. The examiner shall utilize a reserve worksheet which has been approved by the CPEIA pursuant to that JPA's Resolution Establishing a Claims Management Policy. Any changes to reserves shall include an explanation for the change. A claims assistant shall have authority to establish reserves not to exceed $3,000. An examiner shall have authority to establish reserves not to exceed $50,000. A senior examiner shall have authority to establish reserves not to exceed $75,000. The supervisor shall have authority to establish reserves not to exceed $150,000. A director, vice president, or president of the TPA shall review and approve all reserves in excess of $150,000. 7. Medical Administration: The TPA shall select a panel of general practitioners, specialists, hospitals, and emergency treatment facilities to which injured employees should be referred, as approved by the City, and the TPA shall regularly review and update the panel. The physician's office will be contacted within five (5) days of notice of all indemnity claims. Such contact will continue as needed during the continuation of temporary disability to assure that treatment is related to a compensable injury or illness. The TPA shall maintain contact with treating physicians to ensure employees receive proper medical treatment and are retumed to full or modified employment at the earliest possible date. The TPA shall maintain direct contact with medical service providers to ensure their reports are received in a timely manner. The TPA shall arrange medical evaluations when needed, reasonable, and/or requested in compliance with the current Labor Code. The TPA shall ensure that medical bills are reduced to the recommended rates established by the Administrative Director of Workers' Compensation. The use of a service contractor is acceptable provided the City's approval is first obtained. The City shall pay for the use and benefits of the services provided. The TPA shall provide, at the City's expense, utilization review and/or professional managed care services on an as-needed basis to injured employees, provided the member city's approval is obtained prior to the provision of such service. 8. Medical Payments: Medical bills will be matched to the file, reviewed for correctness, approved for payment, and paid within time limits established by Labor Code section 4603.2. If all or part of the bill is being disputed, the TPA will notify the medical provider, on the appropriate form letter, within time limits established by Labor Code 4603.2. City of Redwood City WCP Performance Standards Page 2 of 7 July 1. 2005 or -