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Agmt12 Athens Administrators
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Agmt12 Athens Administrators
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Last modified
8/28/2012 2:17:00 PM
Creation date
8/28/2012 2:17:00 PM
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Template:
Agreement
Contractor Name
Athens Administrators
PROJECT NAME
Workers' Compensation Service Agreement
RMP File Number
304
Date
6/25/2012
MO Ref
12-128
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a <br /> i■ <br /> � <br /> r <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 federai government or any other agency associated with <br /> Employer's Workers'Compensation program. <br /> 4.02. Administrator agrees to administer all claims as follows: <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 /> 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 shall include 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 /> ♦ 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 /> 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-eight 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 /> 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 Employer's 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 /> f. Prepare documentation of cases for litigation and continue to monitor legal counsel <br /> representing Employer in legai 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 files 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 /> W illful Misconduct or alleged violation(s)of California Labor Code Section 132(a). At time of <br /> case referral to defense counsel administrator shall 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- Claim Service Agreement- 2012-2014 <br /> 3 <br />
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