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6. CLAIMS ADMINISTRATION: The Administrator shall comply with all performance standards of the <br />City's excess insurer. The Administrator shall also comply with the Administrator's Workers' <br />Compensation Claims Administration Standards, but under no circumstances are they to be construed as <br />having precedence over the performance standards of the City's excess insurer. The Administrator shall <br />also have the authority and responsibility to provide claims administration services, which include: <br />A. Establishing an electronic claim file and computer database record upon receipt of an injury <br />report. <br />B. Setting and updating reserves, <br />C. Initiating and maintaining contact with injured workers or their attorneys. <br />D. Arranging for investigation. <br />E. Determining compensability. <br />F. Preparing and issuing benefit notices, if applicable. <br />G. Arranging for medical treatment and medical services from clinics, facilities, pharmacies, <br />hospitals, specialists, and other vendors as necessary. <br />H. Performing all utilization review services through MedReview, communicating decisions to <br />approve, modify, delay or deny medical treatment in accordance with State law. <br />I. Monitoring disability status by reviewing medical reports and contacting doctors for updates. <br />J. Auditing and reviewing all medical bills through MedReview and paying all properly adjusted <br />medical bills in a timely and accurate manner. <br />K. Paying mileage or medical reimbursements to injured workers. <br />L. Paying temporary disability compensation when appropriate to do so or advising the City of <br />the need to adjust payroll records when salary continuation is applicable. <br />M. Arranging medical exams in conformance with State law to detemiine whether an injured <br />worker's medical condition is permanent and stationary (reached Maximum Medical <br />Improvement/MMI) and what, if any, permanent disability exists. <br />N. Paying the permanent disability compensation in accordance with the law. <br />O. Arranging for attorney representation of the City whenever the need arises subject to final <br />approval of the City. <br />P. Monitoring attorneys and assisting them in preparing cases. <br />Q. Auditing and paying legal expenses subject to authorization of payment by the City. <br />R. Arranging for vocational rehabilitation services when appropriate, monitoring vocational <br />rehabilitation consultants and assisting them as necessary. <br />S. Auditing and paying vocational rehabilitation expenses. <br />T. Attending all hearings that are required by law or where requested by the City. <br />U. Preparing and issuing Vocational Rehabilitation/Supplemental Job Displacement Benefits <br />SJDB) notices. <br />V. Preparing and issuing the permanent disability compensation notices. <br />W. Pursuing subrogation when there is a viable third party subject to authorization by the City. <br />X. Notifying the City and excess insurers of all claims which exceed or may exceed the self- <br />insurance retention; maintaining a liaison among the City and their excess insurers on matters <br />affecting the handling of such claims and arranging for reimbursement to the City of losses in <br />excess of its self-insurance retention. <br />Y. Obtaining settlement authority from the City and negotiating settlement on appropriate claims. <br />Z. Closing claim files when appropriate to do so, <br />AA. Participating when necessary in the interactive process or other medical legal assessments <br />which may affect open claims. <br />BB. Participate fully in any audit performed by the City or by a third party of the City.