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not later than the next business day excluding weekends and holidays), appropriate, and <br />meaningful contact with the injured employee, site supervisor and physician. File will <br />document this contact. If contact is not made, file will document attempts at contact. <br />Documentation will include, but not be limited to, documentation of compensability, <br />mechanism of injury, medical necessity of medical care, orientation of the injured worker, <br />duty status, as well as evidence of meaningful medical, educational, vocational and societal <br />background information relevant to the ability of the injured employee to return to his or her <br />usual occupation. <br />2. Recovery Activity/Subrogation (4 Points) <br />All possible avenues of subrogation/recovery will be thoroughly explored with appropriate <br />follow-up diaries. Employees prior claim history will be investigated and clearly <br />documented in file. <br />3. Documented Communication (4 Points) <br />Evidence/documentation of routine and effective communication between all interested <br />parties involved in the claim: adjuster, nurse case manager, physicians and other health care <br />providers, employer, employee, legal counsel, etc. Information requested from interested <br />parties should be aggressively pursued. When the information is not provided in a reasonable <br />amount of time, follow-ups for the requested information should be sent at regular intervals <br />until the information is provided or the matter otherwise resolved. The file should be clearly <br />documented with the date and description of each new request or follow-up. <br />4. Litigation Management (4 Points) <br />Evidence of proactive litigation activity and plan (i.e., claim management not "abandoned" to <br />defense counsel) and reasonable efforts should be documented and readily evident from the <br />claim file. File will reflect timely response to all legal filings, legal correspondence and <br />proceedings. File will include evidence of a litigation action plan from defense counsel. <br />5. Overall Claim Documentation (8 Points) <br />Claim file documentation must be meaningful and self-explanatory. A "The file must speak <br />for itself' standard will be kept at all times. Actionable events (new information, <br />transactions, correspondence and communication, actions, etc.) must be documented in real- <br />time (i.e., same day). <br />6. Supervisor, Manager Involvement (8 Points) <br />Appropriate supervisory/management involvement will be documented in claim file. <br />Supervisory/management directives will include initial assignment and subsequent directives <br />will include involvement in evaluating reserves, involvement in strategic planning and <br />disposition of claim. Requests by the supervisor/manager for information from interested <br />parties, and follow-ups for that information, should be timely and clearly documented with a <br />date and description of each request and follow-up. <br />Page 26 <br />