164-22 Exhibits to Agreement for Workers Compensation Third Party Administration - 2022.pdf

1. SCOPE OF SERVICES Proposals must be made on the basis that it either meets or exceeds the requirements contained herein. All bidders must be capable of performing the services listed: a. Supervise the Township’s obligation to employees who sustain bodily or neurological injury and/or occupational diseases in the Township’s service or employ. Claims Resolution Corporation (CRC) has developed a team of seasoned claims professionals, many with extensive experience handling programs similar to the Township’s, who possess decades of experience administering New Jersey Workers compensation claims. Our team of claim specialists not only understand NISA 34:15 but also its nuances as it applies to Public Entities such as the Township. b. Maintain accurate records of all detail’s incident to all Workers’ Compensation cases filed against the Township. Agreed. CRC’s RMIS system will track all activity on every reported claim and will allow the Township the ability to produce this data in virtually unlimited ad-hoc report formats. CRC will maintain a claim file for each reported claim including but not limited to file notes, appointments, and financial transactions. All records are presented electronically and secured with redundant back up protocols, Hardy copy files will be stored in a secure, temperature-controlled environment. Document destruction protocols will be established in client servicing instructions which wil! include client approval prior to destruction of any documents. CRC recognizes the need for immediate investigation of ali claims to preserve causality and evidentiary documentation. For Workers’ Compensation claims, three-point contacts are made with the employer, the injured worker, and the treating physician. Contact is made with employer personnel to obtain details of the accident or occupational injury, verification of job duties and any light duty job assignments if appropriate within 24 hours from receipt of the claim. Contact with the claimant is made to obtain details of the injury, job duties, medical history, medical treatment, and recorded statement as needed. If the claimant is out of work, light duty is discussed with the injured worker setting the expectation that they will return to work as soon as possible. CRC adjusters will also contact the treating physician to obtain causal relationship determination, diagnosis, current and

er setting the expectation that they will return to work as soon as possible. CRC adjusters will also contact the treating physician to obtain causal relationship determination, diagnosis, current and future treatment status as well as any job restrictions and/or anticipated return to work dates. Ifthe first attempt is unsuccessful, we will continually follow up until a successful contact is made. In addition, a letter is sent to the injured employee indicating that we are attempting to contact them. The claim adjuster will establish our position regarding compensability as soon as practical. Initial loss reserves are established based on the information known to date within 14 days of completing the investigation, Our claim adjusters are trained to recognize red flag indicators of fraud. When fraud potential is recognized, the claim adjuster will assign one of our approved, licensed private investigation firms to perform surveillance and take any other appropriate investigative action, obtaining client approval as required. CRC will consult with the Township on any cases of suspected fraud prior to assigning any surveillance. An ISO search is completed on