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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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ATTACHMENT B <br />THIRD PARTY LIABILITY CLAIMS ADMINISTRATION <br />SCOPE OF SERVICES <br />ADMINISTRATIVE SERVICES <br />TPA will provide the following administrative services: <br />1. Prepare (with IRC's assistance) and file with the appropriate state agencies all applications, <br />bonds, documentation, and data required (if any) for implementation and continuance of the <br />program. <br />2. Prepare, maintain, and file all records and reports as may be required by legal authorities (state, <br />local, and federal) including Form 1099 and all reporting required for Medicare Secondary <br />Payor provisions. <br />3. Prepare, maintain, and file statistical or other records and reports as required by IRC's excess <br />insurers. <br />4. Prepare, maintain, and file statistical information required by Rating Bureaus or appropriate <br />state agencies. <br />5. Comply fully with all rules, regulations, guidelines or procedures established by IRC and the <br />State of Florida. <br />CLAIMS SERVICES <br />TPA will provide the following claims services: <br />1. Establish reporting procedures which are compatible with the needs and organizational <br />structure of IRC. <br />2. Provide necessary forms and instructions for use. <br />3. Be available on a 24 hour basis, and provide immediate response to claims investigation <br />requests through use of email or cellular telephones. <br />4. Provide a toll-free customer service line for employees. <br />5. Prepare and follow a work plan that has been approved by IRC in the handling of IRC's claims. <br />Prepare and follow a work plan that has been approved by IRC in the handling of IRC's <br />catastrophe claims. <br />6. Receive and examine on behalf of IRC all reports of third party claims including claims by an <br />employee of one Insured against another Insured. <br />Page 19 <br />
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