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I <br /> Scoue 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 cornpensability. <br /> F. Preparing and issuing benefit notices,if applicable. <br /> G. Arranging for medical treatment and medical services from clinics, facilities, <br /> phannacies,hospitals, specialists, and other vendors as necessary. <br /> H. Performing all utilization review services through Medkeview, communicating <br /> decisions to approve,modify,delay or deny medical treatment in accordance with State <br /> law. <br /> I. 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 thnely 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 ImprovementlMMI) and what,if any,permanent disability exists. <br /> N. Paying the permanent disability compensation in accordance with the law. <br /> Q. 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(SJD]3)notices. i <br /> V. Preparing and issuing the permanent disability compensation.notices, <br /> 3 <br /> 1 <br />