Common use of Claims Services Clause in Contracts

Claims Services. 1. Establish reporting procedures which are compatible with the needs of the EMPLOYER. 2. Provide necessary forms and instructions for use. 3. Receive and examine on behalf of the EMPLOYER all reports of employee injury claims. 4. Conduct investigations that will disclose all of the pertinent facts on any accident as deemed necessary to allow determination as to compensability. 5. Accept or deny all reported claims for employee injuries on behalf of the EMPLOYER in accordance with the applicable Workers' Compensation Law. 6. Employ outside professionals such as private detectives, expert witnesses, field claim adjusters and attorneys to assist in the investigation, should it be necessary, at the expense of the EMPLOYER, subject to prior approval by and consultation with EMPLOYER. 7. Review all medical bills and other services for which a claim is being made for reasonableness and conformity to appropriate medical and surgical fee schedules through our specialized Cost Containment Unit. 8. Subject to approval by the EMPLOYER, the COMPANY will adjust and settle all reported claims. Payment of claims will follow city ordinance guidelines and the City Council will approve claims that exceed dollar thresholds as stated in the ordinance. Such settlement is to include preparation and execution of all necessary compromise and release agreements. 9. Prepare and maintain files necessary for legal defense of claims and/or litigation (such as actions for subrogation) or other proceedings. 10. Pay in a timely fashion and for appropriate amount all claims and expenses pertaining thereto from the Working Loss Fund. The Working Loss Fund will be established by the EMPLOYER and will be maintained at a dollar level sufficient to meet the monthly obligations. 11. Conduct an ongoing review of all open cases where appropriate to establish the status of each disabled employee claim in order to bring to an amicable conclusion. 12. Provide EMPLOYER with narrative status reports of major or litigated claims. 13. Provide coordination with rehabilitation of injured employees in the consultation, retraining and reassignment of employees with limited physical abilities arising from covered injuries, at the expense of the 14. In coordination with EMPLOYER, maintain a current roster of qualified physicians for the treatment of covered injuries on a first and specialized basis, as well as maintaining procedures for close liaison with the treating physicians. 15. The EMPLOYER will establish a checking account with its bank, will complete monthly bank reconciliations and pay normal bank account related expenses regarding the checking account(s). 16. Employ outside professionals for field case management, rehabilitation, vocational training and catastrophic case management at the expense of the EMPLOYER subject to prior approval by and consultation with the EMPLOYER.

Claims Services. 1. Establish reporting procedures which are compatible with the needs of the EMPLOYER.the 2. Provide necessary forms and instructions for use. 3. Receive and examine on behalf of the EMPLOYER CITY all reports of employee injury claims. 4. Conduct investigations that will disclose all of the pertinent facts on any accident as deemed necessary to allow determination as to compensability. 5. Accept or deny all reported claims for employee injuries on behalf of the EMPLOYER CITY in accordance with the applicable Workers' Compensation Law. 6. Employ outside professionals such as private detectives, expert witnesses, field claim adjusters and attorneys to assist in the investigation, should it be necessary, at the expense of the EMPLOYERCITY, subject to prior written approval by and consultation with EMPLOYER. 7CITY. 7 Review all medical bills and other services for which a claim is being made for reasonableness and conformity to appropriate medical and surgical fee schedules through our specialized Cost Containment Unit. 8. Subject to approval by the EMPLOYER, the COMPANY will adjust Adjust and settle all reported claims. Payment of claims will follow city ordinance guidelines and the City Council will approve claims that exceed dollar thresholds as stated in the ordinance. Such settlement is to include preparation and execution of all necessary compromise and release agreements. 9. Prepare and maintain files necessary for legal defense of claims and/or litigation (such as actions for subrogation) or other proceedings. 10. Pay in a timely fashion and for appropriate amount all claims and expenses pertaining thereto from the Working Loss Fund. The Working Loss Fund will be established by the EMPLOYER CITY and will be maintained at a dollar level sufficient to meet the monthly obligations. 11. Conduct an ongoing review of all open cases where appropriate to establish the status of each disabled employee claim in order to bring to an amicable conclusion. 12. Provide EMPLOYER CITY with narrative status reports of major or litigated claims. 13. Provide coordination with rehabilitation of injured employees in the consultation, retraining and reassignment of employees with limited physical abilities arising from covered injuries, at the expense of thethe CITY. 14. In coordination with EMPLOYERCITY, maintain a current roster of qualified physicians for the treatment of covered injuries on a first and specialized basis, as well as maintaining procedures for close liaison with the treating physicians. 15. The EMPLOYER will establish a checking account with its bank, will complete monthly bank reconciliations and pay normal bank account related All expenses regarding the maintenance of CITY checking account(s)) to be at the cost of the CITY. 16. Employ outside professionals for field case management, rehabilitation, vocational training and catastrophic case management at the expense of the EMPLOYER CITY subject to prior written approval by and consultation with the EMPLOYERCITY.