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AgdaPkt 2006-05-22
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AgdaPkt 2006-05-22
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11/15/2006 10:51:27 AM
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5/18/2006 3:24:07 PM
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CC Index
CC Index - Document Type
Agenda Packet
Date
5/22/2006
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<br /> 5.1E <br /> Page 14 <br /> 25. Penaltie!:' Late payment of all benefits must include the self-imposed penalty in accordance with <br /> California law. The City will be provided a listing of any administrative penalties paid during the <br /> quarter, which were the responsibility of the TPA, and a check from the TPA payable to the City of <br /> Redwood City for reimbursement. <br /> 26. C2!';e C!n!,;lIre: The supervisor must review all Medical Only claims open beyond ninety (90) <br /> days from the date of entry by the TP A, for potential closure or conversion to Indemnity claim <br /> status. Claims with $3,000 (three thousand dollars) or more paid to date and any claim open <br /> beyond one hundred eighty days from date of entry must be converted to Indemnity status and a <br /> reasonable, precautionary indemnity reserve placed on the claim(s). All indemnity cases where <br /> -------....,.-...--..-...---.--..pem1anentdisabjJjty....is.,.lloLan ..issue....will.._be....c1osed....within..sixty_..(6Q) ...day.s..of.Jb!:)_.final.. fin::mcial <br /> transaction or final correspondence to the injured worker as required by law. All indemnity <br /> claims where permanent disability is an issue will remain open for two (2) years from the last <br /> payment of benefit and then closed within sixty (60) days of that date. The TPA will monitor <br /> stipulated cases with future medical provisions. Reserves for future medical will be reviewed <br /> semi-annually and adjusted according to use, <br /> 27. Stflt!]!'; Repnrt!'i: Special claim status reports requested by member cities outside the regular 90- <br /> day status reports shall be provided by the TP A to the respective city within ten (l0) business <br /> days. Verbal status reports requested by member cities shall be provided by the TP A to the <br /> respective city within two (2) business days. Special computer generated loss data reports <br /> requested by member cities shall be provided within twenty (20) business days. <br /> 28. Claim!: Repnrting' The TPA shall maintain all loss information as required by the Workers' <br /> Compensation Insurance Rating Bureau. <br /> The TPA shall assist in the preparation of all reports that are now, or will be required by the <br /> State of California or other government agencies with respect to self-insurance programs. The <br /> TPA will also assist in the preparation of all reports or databases required by the California <br /> Institute for Public Risk Analysis (CIPRA) or other statistical database organizations as <br /> requested by the City. <br /> 29. Recnrci Retention' All claim files shaH be maintained in accordance with statutory time <br /> requirements and the City's Record Retention Policy. <br /> 30. c:1aim Sllpervi~ion' The TPA shall provide supervisory staff that will regularly review the work <br /> product of the claims examiners. The supervisor shall review at least ten percent (10%) of each <br /> examiner's case load each month to ensure each examiner is following the performance standards <br /> outlined in this document. In addition, the supervisor shall conduct a regular quarterly review of <br /> all open indemnity claims with reserves in excess of $100,000 and all problem or complex <br /> claims. <br /> 31. Availahility nf Per~nnnel' The TPA shall ensure at least one (1) or more of the examiners <br /> assigned to the City of Redwood City are on-site and available to the City every business day <br /> throughout the term of the approved contract between the City and the TP A. <br /> 32. Fxaminer Training' The TPA shall annually certify to the City of Redwood City that each claims <br /> examiner handling the City's claims is in compliance with all legal and regulatory licensing and I <br /> \ <br /> City of Redwood City Perfonnance Standards Page 6 of7 April 28, 2006 <br />
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