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2019-097B
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2019-097B
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Last modified
12/27/2019 1:35:44 PM
Creation date
7/23/2019 3:03:42 PM
Metadata
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Template:
Official Documents
Official Document Type
Miscellaneous
Approved Date
06/18/2019
Control Number
2019-097B
Agenda Item Number
8.K.
Entity Name
Johns Easter Company, Inc.
Subject
Third Party Claims Administration Services
Area
self funded Workers' Compensation and Liability Program
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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 />
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