Agmt 09 Athens Administrators - Laserfiche WebLink

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. .'"., ," ] "iI' - ::~N~:^~: l.... }~ " ~ _ ~ 1, , . b. Manage timely receipt of all pertinent claim information from Employer providers and other somces. c. Determine, on behalf of Employer for each reported employee injury or illness, those benefits, ifany that should be paid or rendered under the California Workers' Compensation La.ws. Such determination sball 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: . AOFJCOE 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 il\iured 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 ofreported and actual claim status. Employer shall have prior approval of the selection of any investigator used to investigate Employer's claims ofindustrial iIijury or illness. Take necesS8lY statements and investigate facts of the case within thirty (30) days receipt of claim, when warranted. t: Prepare documentation of cases for litigation and continue to monitor legal counsel representing Employer in legal action(s) and assist counsel as necessuy in preparation of litigation. Employ~r 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 sball 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(a). At time of case referral to defense counsel administrator shall prepare a letter of direction to defense counsel outlining work to be done, by whom, and in what time frame. All assignments, instructions and communication with defense counsel must be documented in the claim file and computer note pads. Administrator shall manage defense counsel on an ongoing basis and obtain status reports from defense counsel every siXty (60) days. Administrator shall actively manage litigated files and not perform functions and shall not require defense counsel to perform activities which can be accoIllPlished effectively by claims staff. Administrator shall obtain defense counsels' written evaluation within sixty (60) days ofmbmission, including evaluation of liability, verdict potential, settlement value, and case strategy. g. Disburse payment on behalf of Employer out of the bank trust account funded by Employer, all "Allocated Loss Expenses", which is defined to include all costs incmred on behalf of Employer specifically related to an individual claim, including but not limited to, attomeys, independent adjusters or investigators, expert witnesses, copying records or transcripts, court costs or Appeals Board fees or other costs deemed proper and necessary to represent Employer. h. Use best efforts to achieve an average monthly closme ratio of one hundred percent (100%) over the term of this Agreement. i Examine on ~ehalf. of Employer all reports. of industrial injury or illness relating to Employer's employees or former entployees and reported to Administrator and to conduct investigations on such city of Redwood City. Claim Service Airccment. 2009 through 2010 3