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2016-137
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2016-137
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Last modified
9/16/2016 11:37:49 AM
Creation date
9/16/2016 11:37:46 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/13/2016
Control Number
2016-137
Agenda Item Number
8.V.
Entity Name
Johns Eastern Company Inc.
Subject
Third Party Administration Services
Self Funded Worker's Compensation and Liability
Project Number
UPC 3228
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ATTACHMENT A <br /> WORKERS' COMPENSATION CLAIMS ADMINISTRATION <br /> SCOPE OF SERVICES <br /> ADMINISTRATIVE SERVICES <br /> TPA will provide the following administrative services: <br /> 1. In accordance with state mandated time frames,prepare(with IRC's assistance)and file with the <br /> appropriate state agencies all applications, bonds, documentation, and data required(if any)for <br /> implementation and continuance of the program. <br /> 2. In accordance with state mandated time frames,prepare,maintain,and file all records and reports <br /> as may be required by legal authorities (state, local, and federal). <br /> 3. Prepare, maintain, and file statistical or other records and reports as required by IRC's excess <br /> insurers. Report claims to IRC's excess insurer(s) in accordance with the requirements of the <br /> excess insurer(s). Provide a copy of the reports to IRC. Follow specific written investigation <br /> procedures for any case for which excess Workers' Compensation insurers require specific <br /> notification or investigation. It is the responsibility of IRC to provide accurate coverage <br /> information regarding any insurance policies insuring claims covered by this Agreement. New <br /> insurance information on renewal years will be made within 90 days of renewal date. Excess <br /> information will include name and claims reporting address and phone number of all carriers, <br /> policy number,effective dates, limits of liability,deductibles, specific retentions and loss funds. <br /> Actual polices will be provided. This information is required for each claim year that TPA is <br /> handling for IRC. If this information is not made available as outlined in this paragraph, TPA <br /> will not be responsible for any penalties, interest, or reductions in excess recoveries because of <br /> late reporting. <br /> 4. In accordance with state mandated time frames,prepare,maintain,and file statistical information <br /> required by Workers' Compensation Rating Bureaus or appropriate state agencies, including <br /> electronic data interface (EDI) and data necessary for the promulgation of experience <br /> modifications. <br /> 5. Comply fully with all rules, regulations, guidelines or procedures established by IRC and the <br /> State of Florida, including EDI. <br /> 6. Provide IRC, annually, with the latest paylag report from the State of Florida. <br /> 7. Annually, provide IRC with a SSAE-16 audit as required by the financial auditors. <br /> 8. Prepare and follow provisions specific to IRC,for approval by IRC, for ensuring services in the <br /> event of an emergency;e.g.,hurricane preparedness,including how TPA services will continue, <br /> Page 13 <br />
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