North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS RESERVES Expectation: Due by the 7th day from the date reported. Reserves should be reviewed every time a specialist is in the file. Reserves should reflect exposure for the outcome on the file. Please adhere to account handling instructions. Example: The reserves are prepared for what we know the claim to be at this time. Reviewing the reserves for possible increase updated medical / IME opinion / Settlement evaluation from defense / File will be reviewed, and reserves will be posted accordingly. Target: Projection: 26 weeks of TTD $5000 + 15% of an arm $15,000 = $20,000 Reserve # 0 has been created for WELBER BERALDO DE OLIVEIRA AMORIM. Reference #: null Original Effective Date: 11-15-2021 10:56 AM. Amounts By Category: - MEDICAL: $ 3,500.00 - ALAE: $ 250.00 - ULAE: $ 0.00 Change By Category: - MEDICAL: +$ 3,500.00 - ALAE: +$ 250.00 - ULAE: $ 0.00 Example Note: This is a Wisconsin claim from July (07/13/2021) in which a 38-year-old road machine operator was working on a construction project when he was backing a skid steer and hit a roller machine sustaining an injury to his neck at C7. He is now in need of an artificial disc replacement at the C6-C7 level as he sustained herniation with foraminal and lateral recess stenosis. Compensability has been addressed with the surgeon, who opined that the 07/13/2021 incident was the major contributing factor to the injured workers’ neck issues. Subrogation has been ruled out because both pieces of equipment were owned and operated by the employer/employees. Projecting 26wks of TTD $5000 = 15% of an arm = $20,000 & Medical of $75,000 is spelled out in reserve calculation. Utilize C3 Template. 22 23