C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation BEST PRACTICES NARS W • appropriate worker Class Code for the insured NAICS code a • other coverages potentially applying to the loss y • injured worker status • evaluation for potential of cumulative trauma or occupational disease U W nit MC C anagr • Coverage is determined as soon as the facts and circumstances of the claim and investigation will reasonably allow. edo f er or • Coverage analysis and application of that coverage to the facts is the beginning of the investigative process of each s new claim, and is followed by the basic investigative steps, including timely and clearly communicated decisions to f the involved parties on the claim, which are documented in the claim file. or W S C C pecialistsr • Should coverage analysis yield determination of no coverage, application of no coverage to be documented in the edo claim file including timely and clearly communicated decisions to the involved parties on the claim. INVESTIGATION: P r acticB • Investigation is the development of facts and continues throughout the life of the claim. es est • Investigative tools available to the Workers’ Compensation Claims Specialist include, but are not limited to: U • Loss reports, police reports, medical reports, photographs, diagrams, Index results, statements from involved parties Checklistnit M and witnesses, experts, receipts, NICB, ODG, claims-related websites, claims handling guidelines, social media, anag surveillance, etc. er • Conduct a pro-active and thorough investigation to resolve the critical/unresolved issues regarding Coverage, Compensability, and Exposure. ChecklistSW COMPENSABILITY: pecialist C Claims • The WC Claims Specialist is responsible for exercising reasonable judgment, based on experience, in arriving at liability and/or compensability decisions within his or her prescribed authority level subject to oversight by Expecta management. 14 D F a tionsile • The investigative material is reviewed and objectively evaluated to determine whether to pay, adjust, compromise, y or deny the presented claim in a timely manner. s • As decisions are made concerning the claim being investigated, they should be documented in the claim file. Expecta F • Evaluation of compensability is a continual process that is refined as necessary as the investigation develops and any tionsile medical treatment progresses. R EXPOSURE: e f er D • Timely and accurate assessment of exposure begins at the inception of a claim and is achieved by prompt and clear encisability requests for information, continual evaluation of information, and prompt verification of information. e G uide • Information is collected to form the basis of the WC Claims Specialist’s informed decision on the value and exposure of the claim. Ca N t o eg t NARS’ Best Practices were created by and for the internal use of NARS and are confidential, proprietary and trade secret documents protected by the Uniform orieses and Trade Secrets Act and applicable state/federal law. They may not be copied, distributed, or reproduced, in whole or in part, without NARS’ express prior written 4 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties. 5