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Agmt06 Claims Management Inc.
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Agmt06 Claims Management Inc.
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Last modified
6/29/2007 9:32:40 AM
Creation date
7/5/2006 12:08:20 PM
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Template:
Agreement
Contractor Name
Claims Management Inc.
PROJECT NAME
Worker's Comp Administrative Services
RMP File Number
304
Date
7/1/2006
MO Ref
06-094
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<br />8. <br /> <br />The TPA shall provide, at the City's expense, utilization review and/or professional managed <br />care services on an as-needed basis to injured employees, provided the City's approval is <br />obtained prior to the provision of such service. <br /> <br />Medic::II P::Iyments' Medical bills will be matched to the file, reviewed for correctness, approved <br />for payment, and paid within time limits established by Labor Code section 4603.2. If all or part <br />of the bill is being disputed, the TP A will notify the medical provider, on the appropriate form <br />letter, within time limits established by Labor Code 4603.2. <br /> <br />9. PI::ln of Action' Each claim file shall contain the examiner's plan of action for the future <br />- -handling of that claim. Such plan of action will be identified in the computer n()!~pad. <br /> <br />10. <br /> <br />11. <br /> <br />Investie:Jtion' The TPA shall subscribe to the Index Bureau. The examiner shall request <br />a report from the Index Bureau on all new indemnity claims. Subsequent requests should <br />be made every six (6) to twelve (12) months thereafter on all active indemnity claims. <br /> <br />Compens::lhility. The compensability determination (accept claim, deny claim, or delay <br />acceptance pending the results of additional investigation) and the reasons for such determination <br />will be made and documented in the file within three (3) working days of the receipt of the <br />notification of the loss. Delay or denial of benefit letters shall be mailed in compliance with the <br />Division of Industrial Relations' guidelines. The TP A shall notify the City of delay or denial of <br />any claim. <br /> <br />In no case shall a final compensability decision be extended beyond ninety (90) days from the <br />City's knowledge of the claim. <br /> <br />12. <br /> <br />Provision of Benefits' The TP A shall provide all compensation and medical benefits in a timely <br />manner and in compliance with the statutory requirements of the California Labor Code. The <br />TP A shall compute and pay temporary disability benefits to injured employees based upon <br />earnings information and authorized disability periods. The TP A shall review, compute, and pay <br />all informal ratings, death benefits, Findings and Awards, life pensions, or Compromise and <br />Release settlements. <br /> <br />13. <br /> <br />lniti::ll Indemnity P::Iyment: The initial indemnity payment or voucher will be issued and mailed <br />to the injured employee together with properly completed DWC notices within fourteen (14) <br />days of the first day of disability. <br /> <br />Late payments must include the ten percent (10%) self-imposed penalty in accordance with <br />Labor Code Section 4650. <br /> <br />14. <br /> <br />SlIhseqllent Indemnity P::Iyments' All indemnity payments or vouchers subsequent to the first <br />payment will be verified, except for obvious long-term disability, and issued in compliance with <br />Labor Code Section 4651. <br /> <br />Late payments must include the ten percent (10%) self-imposed penalty in accordance with <br />Labor Code Section 4650. <br /> <br />City of Redwood City Perfonnance Standards <br /> <br />Page 3 of7 <br /> <br />April 28, 2006 <br />
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