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Scone of Services <br />Third Party Administration of <br />Workers' Compensation Claims Program <br />CLAIMS ADMINISTRATION <br />The Consultant shall comply with all performance standards of the City's liability pool and any <br />excess insurers. The Consultant shall also have the authority and responsibility to provide claims <br />administration services, which include; <br />A. Establishing an electronic claim file and computer database record upon receipt of an <br />injury 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, <br />pharmacies, hospitals, specialists, and other vendors as necessary. <br />H. Performing all utilization review services through MedReview, communicating <br />decisions to approve, modify, delay or deny medical treatment in accordance with State <br />law. <br />1. Monitoring disability status by reviewing medical reports and contacting doctors for <br />updates. <br />J. Auditing and reviewing all medical bills through MedReview and paying all properly <br />adjusted 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 <br />City of the need to adjust payroll records when salary continuation is applicable. <br />M. Arranging medical exams in conformance with State law to determine whether an <br />injured worker's medical condition is permanent and stationary (reached Maximum <br />Medical 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 <br />final 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 <br />vocational 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 <br />Benefits (SJDB) notices. <br />V. Preparing and issuing the permanent disability compensation notices. <br />