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obtaining medical care. <br />9. Provide advance notice and coordinate in advance with IRC any internal audits associated with <br />the Workers' Compensation program. <br />10. Assist IRC with its Return to Work program, including identifying return to work <br />opportunities and appropriate use of outside vendors. <br />CLAIMS SERVICES <br />TPA will provide the following claims services: <br />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. Provide customer service lines with a toll-free line for employees. <br />4. Develop specific service instructions with IRC for the handling of IBC's claims. Develop <br />specific service instructions with IRC for the handling of IBC's catastrophic claims. <br />5. Conduct such investigation into the specifics of each individual report of employee injury as <br />in the exercise of professional judgment would seem necessary. Enhanced efforts shall be taken <br />to identify possible fraudulent claims including recorded statements from claimants and <br />discussions with the claimant's supervisors. <br />6. Subject to the exercise of professional judgment, accept and settle or deny all reported claims for <br />employee injuries on behalf of IRC in accordance with the applicable Workers' Compensation <br />Law or law of damages. When it appears the final value of any claim will exceed a discretionary <br />limit of $10,000, IRC shall be notified and the final decision for settlement shall rest with IRC. <br />Any settlement is to include preparation and actuation of all necessary stipulations, compromise, <br />and release agreements. <br />7. 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 />services, Translation services, Transportation services, Surveillance and Investigation <br />services, Medicare Set -Aside services and Court Reporting services. <br />(b) TPA will review all bills for such services for reasonableness and conformity to any <br />preestablished rates or fees and will adhere to any set pricing schedules. <br />(c) TPA will work collaboratively with these outside professionals, including data <br />sharing, Page 14 <br />169 <br />