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01
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2007
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082107
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01
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8/16/2007 4:31:45 PM
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8/16/2007 4:31:45 PM
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CITY CLERK
CITY CLERK - TYPE
STAFF REPORTS
DOCUMENT DATE
8/21/2007
DESTRUCT DATE
15 Y
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 that <br />have not been closed as of the Effective Date of this Agreement and closed claims <br />that reopen on or after the Effective Date. ICS shall have no responsibility other than <br />custody of files and statistical reporting for claims closed prior to the 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 by <br />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 in <br />a timely and accurate manner and in conformance in all material respects with all <br />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 Board <br />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 ratings, 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 advance <br />authority from the CLIENT. <br />12. As a service to the CLIENT, ICS will report all excess claims to excess reinsurance <br />carrier, although the final responsibility for reporting such claims is that of the <br />CLIENT's. <br />
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