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<br />. <br />. <br /> <br />, <br /> <br />it ! :::N~:A~:- <br /> <br />name and logo, and to prepare all legally required forms and documents Including but not <br />limited to, 1099 reports to the I.R.S. and any and all other documents and reports now or in <br />the future required by the state or federal government or any other agency associated with <br />Employer's Workers' Compensation program. <br /> <br />4.02. Administrator agrees to administer all claims as follows: <br /> <br />a. Establish and maintain a claim file, with a diary date not to exceed thirty (30) days, on each <br />active claim upon which indemnity benefits are being paid; A diary system not to exceed sixty <br />(60) days on all other open, active Indemnity claims; and a supervisory review diary not to <br />exceed one-hundred-twenty (120) days, or more often when needed. <br /> <br />b. Manage timely receipt of all pertinent claim information from Employer providers and other <br />sources. <br />c. Determine, on behalf of Employer for each reported employee injury or illness, those <br />benefits, if any that should be paid or rendered under the California Workers' Compensation <br />Laws. Such determination shalllndude an estimate of future claim payment. Retain outside <br />services with prior approval of Employer, for the investigation and management of the claims. <br />Outside services include but are not limited to: <br /> <br />. AOE/COE Investigators <br />. Activities Check/Sub-rosa Investigator; <br />. Medical Case Management and Rehabilitation Nurses/Consultants <br />. Nurses/Consultants <br />. Subrogation Investigators and Experts <br /> <br />d. Exhibit In each Indemnity claim file good faith efforts to contact all Injured workers by <br />telephone within at least twenty-four hours of receipt of claim, and in no event any later than <br />forty-elght hours. of receipt of claim, excluding weekends and holidays. Establish phone <br />contact with appropriate Employer department for Initial discussion of claims, as needed, <br />within three (3) working days of receipt of claim. <br /> <br />e. Initiate investigations, subject to approval by Employer, to determine compensability of <br />reported and actual claim status. Employer shall have prior approval of the selection of any <br />investigator used to Investigate Employer1s claims of industrial Injury or Illness. Take <br />necessary statements and investigate facts of the case within thirty (30) days receipt of claim, <br />when warranted. <br /> <br />f. Prepare documentation of cases for litigation and continue to monitor legal counsel <br />representing Employer in legal action(s) and assist counsel as necessary in preparation of <br />litigation. Employer shall select and approve counsel prior to each referral. In addition, <br />Administrator shall promptly provide Employer with copies of all correspondence generated <br />on those claim flies which are litigated and shall immediately notify Employer in writing and <br />shall keep Employer closely informed on those claims Involving allegations of Serious and <br />Willful Misconduct or alleged violation(s) of California Labor Code Section 132(a). At time of <br />case referral to defense counsel administrator ~hall prepare a letter of direction to defense <br />counsel outlining work to be done, by whom, and in what time frame. All assignments, <br />instructions and communication with defense counsel must be documented in the claim file <br />The CIty of Redwood CIty - Oalm Service Agreement - 2010 - 2012 <br /> <br />3 <br />