AgdaPkt 2009-06-15 clsd and spc - Laserfiche WebLink

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6.10 Page 6 e. Provide all forms and supplies necessary for the efficient operation of the Workers' Compensation insurance program, including customized benefit checks bearing Employer's name and logo. and to prepare all legally required forms and documents including but not limited to, 1099 reports to the I.R.S. and any and all other documents and reports now or in the future required by the state or federal government or any other agency associated with Employer's Workers' Compensation program. 4.02. Administrator agrees to administer all claims as follows: a. Establish and maintain a claim file. with a diary date not to exceed thirty (30) days, on each active claim upon which indemnity benefits are being paid: A diary system not to exceed sixty (60) days on all other open. active Indemnity claims: and a supervisory review diary not to exceed one-hundred-twenty (120) days. or more often when needed. b. Manage timely receipt of all pertinent claim information from Employer providers and other sources. c. Determine, on behalf of Employer for each reported employee injury or illness. those benefits, if any that should be paid or rendered under the California Workers' Compensation Laws. Such determination shall include an estimate of future claim payment. Retain outside services with prior approval of Employer, for the investigation and management of the claims. Outside services include but are not limited to: . AOE/COE Investigators . Activities Check/Sub-rosa Investigator: . Medical Case Management and Rehabilitation Nurses/Consultants . Subrogation Investigators and Experts d. Exhibit in each Indemnity claim file good faith efforts to contact all injured workers by telephone within at least twenty-four hours of receipt of claim, and in no event any later than forty-eight hours of receipt of claim, excluding weekends and holidays. Establish phone contact with appropriate Employer department for initial discussion of claims. as needed. within three (3) working days of receipt of claim. e. Initiate investigations, SUbject to approval by Employer, to determine compensability of reported and actual claim status. Employer shall have prior approval of the selection of any investigator used to investigate Employer's claims of industrial injury or illness. Take necessary statements and investigate facts of the case within thirty (30) days receipt of claim, when warranted. f. Prepare documentation of cases for litigation and continue to monitor legal counsel representing Employer in legal action(s) and assist counsel as necessary in preparation of litigation. Employer shall select and approve counsel prior to each referral. In addition. Administrator shall promptly provide Employer with copies of all correspondence generated on those claim files which are litigated and shall immediately notify Employer in writing and shall keep Employer closely informed on those claims involving allegations of Serious and Willful Misconduct or alleged violation(s) of California Labor Code Section 132(0). At time of case referral to defense counsel administrator shall prepare a letter of direction to defense counsel City of Redwood City - Claim Service Agreement - 2009 through 2010 3