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2. Medical Plan of Action Documentation (8 Points) A written plan of action must be established jointly between the adjuster and, as appropriate, supervisor or case manager within the following intervals: a. Within 10 days of the TPA's knowledge of a claim, b. Within 30 days of the TPA's knowledge of a claim, c. At quarterly intervals thereafter, as long as a claim remains open. The plan of action must include, as appropriate, the medical resources required (field nurse case manager, specialist referral, transportation, attendant care, etc.), the diagnosis, prognosis, proposed treatment plan, authorized physicians and other providers, description and cost of prescribed medications, the Medicare set aside strategy and anticipated MMI, current work status and stay -at -work or return -to -work plan. File documentation will include a clear understanding by adjuster direction, strategy and "who" is going to do "what" to ensure successful result. End result desired or expected will be clearly documented. 3. Timely Care/Treatment/Quality Referral & Authorization Process (8 Points) Needed medical appointments with specialists, physical therapists, diagnostic tests, etc. must take place within 7 days of a request for service by an authorized party and appropriate to the diagnosis. If appointment for appropriate service is not available within 7 days of request/referral, file must document reasonable attempts to procure such appointment. The TPA must provide a substantive and written cover letter and chronologically arranged medical records to any independent medical examiner at least 5 days prior to an independent medical examination appointment date or, as appropriate, provide the documents in a timely manner to defense counsel on the appointments that they are to schedule. The information assembled must be thorough and provided in such a manner as to be meaningful and self- explanatory. 4. Stay-at-Work/Return-to-Work Communication & Documentation (8 Points) The IRC Workers' Compensation Coordinator must be notified in writing, no later than the next business day of the TPA's knowledge, that an employee has been given limitations/restrictions or other altered duty status. The file must always clearly document work status. CLAIMS MANAGEMENT — 36 Points 1. Timely Reporting, Quality Contact (for new claims) (8 Points) Adjuster will make timely (within 24 hours for lost -time and 48 hours for medical -only, but not later than the next business day excluding weekends and holidays), appropriate, and meaningful contact with the injured employee, site supervisor and physician. File will Page 25