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01
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2011
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062111
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01
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6/17/2011 3:20:33 PM
Creation date
6/16/2011 3:20:55 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
6/21/2011
DESTRUCT DATE
15Y
DOCUMENT NO
01
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Exhibit A <br /> A. Claims Administration.ICS shall adhere to the following claims administration <br /> standards and procedures: <br /> 1. ICS shall review and process reported claims for workers' compensation benefits <br /> that have not been closed as of the Effective Date of this Agreement and closed <br /> claims that reopen on or after the Effective Date. ICS shall have no responsibility <br /> other than custody of files and statistical reporting for claims closed prior to the <br /> Effective Date. <br /> 2. Determine liability for claimed injuries and illnesses in accordance with California <br /> Workers' Compensation Laws. <br /> 3. Review and process all claims in accordance with rules and regulations established <br /> by the Division of Industrial Relations, Department of Self-Insurance Plans. <br /> 4. Establish files containing medical and factual information on each reported claim <br /> together with complete accounting records and maintain same in accordance with <br /> statutory time requirements. <br /> 5. ICS shall make all workers compensation disability payments and send all notices <br /> in a timely and accurate manner and in conformance in all material respects with <br /> all applicable provisions of the California Labor Code and the California workers' <br /> compensation laws, rules and regulations. <br /> 6. Determine nature and extent of permanent disability and arrange for informal <br /> disability rating whenever possible to avoid Workers' Compensation Appeals <br /> Board litigation. <br /> 7. Explain to and assist employee in completing necessary forms for permanent <br /> disability ratings. <br /> 8. Review compute and pay all informal rating, findings and awards, life pensions or <br /> compromise and release settlements. <br /> 9. Maintain and establish reserve estimates for each reported claim. <br /> 10. Arrange for and supervise all necessary investigations to determine eligibility for <br /> compensation benefits and/or liability of negligent, third parties. <br /> 11. Identify, recommend and obtain special fraud investigations after obtaining <br /> advance authority from the CLIENT. <br />
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