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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
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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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(c) TPA will work collaboratively with these outside professionals, including data sharing, <br /> portals and other methods for sharing information. If there are any programming fees <br /> associated with sharing this data,IRC or the outside professionals will cover these costs. <br /> 8. Review all medical bills and bills for other services for which a claim is being made for <br /> reasonableness and conformity to rules,regulations,and legally imposed medical and surgical fee <br /> schedules. <br /> 9. Prepare and maintain files necessary for legal defense of claims and/or other litigation(such as <br /> actions for subrogation, contribution, or indemnity) or other proceedings. <br /> 10. Where appropriate or desirable,attend hearings,depositions,mediations,and other proceedings. <br /> The adjuster handling the claim file will provide an updated written file note within 48 hours <br /> after the hearing, deposition, mediation or other proceeding. <br /> 11. At the request of IRC,provide a complete copy of all files involving litigation,potential or actual <br /> subrogation, or potential or actual recovery from special or second injury funds to the Risk <br /> Manager or the designee thereof. <br /> 12. Aggressively pursue all possibilities of subrogation,excess insurance reimbursement,third party <br /> liens,contribution or indemnity and/or recovery from special or second injury funds on behalf of <br /> IRC. <br /> 13. Periodically as appropriate, but at least every quarter, review all open cases and complete a <br /> strategic action plan in order to assist in the settlement of the cases. Such written reviews shall <br /> include a review and verification of outstanding reserves. A written summary of the review shall <br /> be documented in the open case file and shall be provided to IRC within ten working days after <br /> the end of the period for which the report is being made. <br /> 14. Provide access to rehabilitative services for injured employees including consultation for <br /> retraining or reassignment of employees with limited physical performance arising from covered <br /> injuries. <br /> 15. The supervising adjuster shall meet with IRC's Risk Manager,or the designee thereof,to consult <br /> with and refer all questionable or contested cases and those with an estimated value in excess of <br /> $10,000. <br /> 16. Aid in communications/coordination with IRC's safety and loss control program staff as <br /> necessary including providing claims data needed to target safety and prevention initiatives. <br /> Page 15 <br /> I <br />
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