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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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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 <br />her 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 parties <br />involved in the claim: adjuster, nurse case manager, physicians and other health care providers, <br />employer, employee, legal counsel, etc. Information requested from interested parties should <br />be aggressively pursued. When the information is not provided in a reasonable amount of time, <br />follow-ups for the requested information should be sent at regular intervals until the <br />information is provided or the matter otherwise resolved. The file should be clearly documented <br />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" <br />to defense counsel) and reasonable efforts should be documented and readily evident from <br />the 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 <br />real-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 />FINANCIAL MANAGEMENT — 32 Points <br />1. Reserves (8 Points) <br />Page 26 <br />
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