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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
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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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7. Report claims to IRC's excess insurer(s) in accordance with the requirements of the excess <br />insurer(s). Provide a copy of the report to IRC. Follow specific written investigation <br />procedures for any case for which the excess insurer requires specific notification. It is the <br />responsibility of IRC to provide accurate coverage information regarding any insurance policies <br />insuring claims covered by this contract. New insurance information on renewal years will be <br />made within 90 days of renewal date. Excess information will include name and claims reporting <br />address and phone number of all carriers, policy number, effective dates, limits of liability, <br />deductibles, specific retentions and loss funds. Actual polices will be provided. This information <br />is required for each claim year that TPA is handling for IRC. If this information is not made <br />available as outlined in this paragraph, TPA will not be responsible for any penalties, interest, or <br />reductions in excess recoveries because of late reporting. <br />8. Within 24 hours after notification of a serious (one requiring more than first aid) third party bodily <br />injury claim, contact the claimant by telephone or in person. Within two working days after <br />notification of any other third party claim, contact the claimant by telephone or in person. <br />9. Subject to the exercise of professional judgment, accept and settle or deny all third party claims <br />on behalf of IRC. When it appears that the claim is questionable or contested or the final value <br />of any claim will exceed a discretionary limit of $10,000, IRC shall be notified and the final <br />decision for settlement shall rest with IRC or its designee. Any settlement is to include <br />preparation and actuation of all necessary compromise and release agreements. <br />10. Conduct such investigation, field or telephonic, as in the exercise of professional judgment <br />would seem necessary. Follow specific written investigation procedures for any case for which <br />the excess insurer requires specific notification. <br />11. IRC may select and employ outside professionals such as surveillance personnel, expert <br />witnesses, and attorneys to assist in the investigation, adjustment, and defense of claims. <br />(a) IRC may select specific vendors and pricing schedules for the following services: Legal, <br />Surveillance and Investigation services, and Medicare Set -Aside (CMS) services. <br />(b) TPA will review all bills for such services for reasonableness and conformity to any pre- <br />established rates or fees and have the ability to adhere to any set pricing schedules. <br />(c) TPA will work collaboratively with these outside professionals. <br />IRC will be involved in the selection process for such outside professionals and will be <br />involved in establishing effective utilization decision making criteria. <br />12. 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 />Page 20 <br />
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