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2024-237
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2024-237
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Last modified
10/21/2024 11:45:59 AM
Creation date
10/21/2024 11:41:35 AM
Metadata
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/24/2024
Control Number
2024-237
Agenda Item Number
8.P.
Entity Name
Davies Claims North America, Inc.
Subject
Third Party Claims Administration Services Agreement for the Self-Funded Workers’
Compensation and Liability Program
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19. Develop and follow appropriate written policies when (i) the injured employee requests a <br />second opinion, (ii) medical evaluation is questioned, or (iii) grievance report is filed. <br />20. Assist, as appropriate, in the scheduling of independent medical examinations. <br />21. Monitor the purchase of items deemed to be medically necessary for the accommodation <br />of an injured employee and obtain approval from the Risk Manager for those items with a cost <br />greater than $10,000. <br />22. Follow all provisions of Florida Statute in regard to medical benefit entitlement and <br />administration. <br />FIRST NOTICE OF INJURY SERVICES <br />TPA will provide the following administrative services: <br />1. Provide internet based claim reporting and intake capabilities. Send First Notice of Injury to <br />the State of Florida in a timely manner. TPA must accept responsibility for penalties for late <br />notice to the State of Florida when caused by other than the delay of IRC. <br />2. Receive and examine on behalf of IRC all reports of employee injury claims. Refer injured <br />workers to appropriate medical services, and as appropriate and based upon pre -established <br />criteria agreed upon by IRC. Provide immediate referral to network specialty medical providers <br />for injuries. <br />3. Coordinate data between first report of injury and claims administration system. <br />4. The on-line claim security shall permit on-line input of accident reports by IRC. <br />TELEPHONIC MEDICAL MANAGEMENT <br />TPA will provide the following services: <br />1. Telephonic Nurse Case Management services will be provided by TPA staff for all lost time <br />and select medical only claims. <br />2. Pre -Certification of Hospital Admissions. <br />LOSS STATISTICS SERVICES <br />TPA shall provide IRC with the ability to access comprehensive on-line, real-time electronic claim <br />information data, including reporting capabilities, at no additional cost to IRC. TPA shall provide <br />IRC with regular monthly reports, as agreed upon by the parties, in such a format as is acceptable <br />to IRC. <br />Page 16 <br />
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