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7.1.E. - Page 6 ATHENS <br /> ADMINISTRATORS <br /> the future required by the state or federal 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 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 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 /> Willful 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 /> and computer note pads. Administrator shall manage defense counsel on an ongoing basis <br /> and obtain status reports from defense counsel every sixty (60) days. Administrator shall <br /> The City of Redwood City- Claim Service Agreement- 2014-2015 <br /> 3 <br /> ATTY/AGR/2014.073/ATHENS WORKER'S COMPENSATION <br /> REV:05-23-14 MLG <br /> Page 3 of 11 <br />