2019-097B - Laserfiche WebLink

Home Browse Search

6. Receive and examine on behalf of IRC all reports of third party claims including claims by an employee of one Insured against another Insured. 7. Report claims to IRC's excess insurer(s) in accordance with the requirements of the excess insurer(s). Provide a copy of the report to IRC. Follow specific written investigation procedures for any case for which the excess insurer requires specific notification. It is the responsibility of IRC to provide accurate coverage information regarding any insurance policies insuring claims covered by this contract. New insurance information on renewal years will be made within 90 days of renewal date. Excess information will include name and claims reporting address and phone number of all carriers, policy number, effective dates, limits of liability, deductibles, specific retentions and loss funds. Actual polices will be provided. This information is required for each claim year that TPA is handling for IRC. If this information is not made available as outlined in this paragraph, TPA will not be responsible for any penalties, interest, or reductions in excess recoveries because of late reporting. 8. Within 24 hours after notification of a serious (one requiring more than first aid) third party bodily injury claim, contact the claimant by telephone or in person. Within two working days after notification of any other third party claim, contact the claimant by telephone or in person. 9. Subject to the exercise of professional judgment, accept and settle or deny all third party claims on behalf of IRC. When it appears that the claim is questionable or contested or the final value of any claim will exceed a discretionary limit of $10,000, IRC shall be notified and the final decision for settlement shall rest with IRC or its designee. Any settlement is to include preparation and actuation of all necessary compromise and release agreements. 10. Conduct such investigation, field or telephonic, as in the exercise of professional judgment would seem necessary. Follow specific written investigation procedures for any case for which the excess insurer requires specific notification. 11. IRC may select and employ outside professionals such as surveillance personnel, expert witnesses, and attorneys to assist in the investigation, adjustment, and defense of claims. (a) IRC may select specific vendors and pricing schedules for the following services: Legal, Surveillance and Investigation services, and Medicare Set -Aside (CMS) services. (b) TPA will review all bills for such services for reasonableness and conformity to any pre- established rates or fees and have the ability to adhere to any set pricing schedules. (c) TPA will work collaboratively with these outside professionals. IRC will be involved in the selection process for such outside professionals and will be involved in establishing effective utilization decision making criteria. Page 20