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5.1E Page 9 Exhibit A CJTV o~ "QFnWOOll..ClIY The following Claims Administration Performance Standards have been adopted by the City of Redwood City. .-..--" ---------,---L---- ..,. ,.Ca!;~Io11d..---Each....examiner.shal}.havea.caseload--not-tl3e*ceed-l.-SOopen-indemnity-elaims-;Eaeh-.-----.--'--- claims assistant shall have a caseload not to exceed 300 open medical only claims. The supervisor shall have a caseload not to exceed 30 open indemnity claims. 2. Fonm;' The TP A shall provide all fonns necessary for the processing of benefits or claims information including the Employer's Report of Injury, OWC Form 1, return to work slips, vouchers, checks, and other related forms. The cost of providing these forms shall be included within the contract price. 3. Claim File Set Or llnd Diary Review' Upon receipt of the Employer's Report ofInjury, the 'IPA will prepare an individual claim file within two (2) working days for each claim. All claim files shall be reviewed at least every forty-five (45) calendar days for active claims and at least every six (6) months for claims that have settled but are open for the employee's future medical care. The examiner shall distinguish the regular diary review from routine file documentation in the computer notepad. The supervisor shall monitor the diary reviews by printing a "No Activity" report each month to identify any files that have fallen offthe diary system. 4, Employer Contact. The TPA shall request the Employer's Report of Injury form when or if notification of an injury or incident by any source is received first (i.e., Application of Adjudication, notice oflegal representation, Doctor's First Report oflnjury, etc.), The 'IPA will confirm the DWC Form 1 was given to the employee within one (1) working day of knowledge of the injury. If there is no evidence the form was provided, the TPA will provide the form with the initial contact letter to the employee within three (3) business days of receiving the claim, The TP A shall contact the City within one (1) working day of receipt of notice of a lost time claim by any source. Such contact with the City shall be documented in the computer notepad after the claim has been created in the system. When a claim reaches or exceeds one half of the City's SIR in total incurred value, the TP A shall report to the City, with a copy to the Workers' Compensation Program Manager, every ninety (90) days regarding the status of the claim. Such report shall include the examiner's plan of action for the future handling of the claim. The examiner will provide on-site file reviews quarterly if requested by the City. Other periodic on~site file revIews will be scheduled based upon the needs of the City, City of Redwood City Perfonnance Standards Page] of7 April 28, 2006 ", -___"__~ _, _____...____._w,.__.,,_~_.~,_.___._.,______".,.,_~.,_ .._.