WC Guidebook single.

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North American Risk Services, Inc. Workers’ Compensation Worker’s Compensation Guidebook Table of Contents NARS Way ............................................................................................................................................................... 1 WC Credo for Unit Managers .................................................................................................................................2 WC Credo for Specialists.........................................................................................................................................3 Best Practices .........................................................................................................................................................4 Unit Manager Checklist ..........................................................................................................................................9 WC Claims Specialists Checklist ............................................................................................................................10 File Expectations - 14 Days ...................................................................................................................................12 Coverage .........................................................................................................................................................12 Initial Injured Worker Contact ........................................................................................................................12 Employer Initial Contact .................................................................................................................................14 Medical Provider/Medical Management ........................................................................................................15 Witness ...........................................................................................................................................................16 Subrogation.....................................................................................................................................................16 Compensability ...............................................................................................................................................17 Wage Benefits .................................................................................................................................................18 Initial - Interim - Status Report .......................................................................................................................19 Medical Only Status Report ............................................................................................................................20 Litigation .........................................................................................................................................................20 File Expectations ...................................................................................................................................................21 EDI/State Filings ..............................................................................................................................................21 Medicare .........................................................................................................................................................21 Reserves ..........................................................................................................................................................22 Disability Management ...................................................................................................................................23 Investigation ...................................................................................................................................................23 Vocational Rehabilitation ................................................................................................................................23 Ongoing Subsequent Communication ............................................................................................................24 Second Injury Fund .........................................................................................................................................24 Nurse Case Management ................................................................................................................................24 Unit Manager Review - Category - Managerial Note ......................................................................................25 Subsequent Unit Manager Quality Claim Management Review (QCM) .........................................................25 Special Investigation Unit................................................................................................................................26 Vendor ............................................................................................................................................................26 Closing Note ....................................................................................................................................................26 Authority/Authority Requested ......................................................................................................................26 Disability Reference Guide ...................................................................................................................................27 Notes and Categories ...........................................................................................................................................29 1

CT onable o t en tsf NARS W a y UW nit MC C anagr edo f eror At NARS, we are always... s f orW SC C pecialistsr Keeping it fun and edo Fanatical about response times celebrating victories P r acticB esest U Operating as a Setting expectations and Checklistnit M high-functioning team following through anag er ChecklistSW pecialist C Claims Holding ourselves Taking pride in our work accountable Expecta 14 DF a tionsile y s Treating everyone with Dedicated to continuous Expecta F respect and empathy improvement tionsile R e f erD encisability Proactive in seeking Delivering what is e G solutions important to our uide stakeholders CaN t o egt orieses and 1

Workers’ Compensation Unit Mangers Credo Workers’ Compensation Unit Managers are extraordinary leaders! WORKERS’ COMPENSATION UNIT MANAGERS ARE PASSIONATE We are energetic and curious to figure out the best ways to lead our team and navigate the workers’ compensation space to exude excellence. We love life and actively craft our environment it to create happiness and reach our goals of improving the workers’ compensation, turning an industry into something magnificent! WORKERS’ COMPENSATION UNIT MANAGERS ARE CREATIVE We celebrate individuality of our team because that celebrates the people we help, our injured workers. Each of us is unique, with different backgrounds and experience with a common goal of leaving each injured worker better than we found them, and an industry full of hope. We are the change agents. The trailblazers. We have a desire to advance the culture in workers’ compensation and create a new reality for the future. WORKERS’ COMPENSATION UNIT MANAGERS ARE INNOVATIVE We embrace technology to find more effective and efficient means to serve our teams and injured workers. We embrace new way of thinking to create, connect, and push the workers’ compensation industry forward. We shape the workers’ compensation industry by focusing on the human elements including the way our teams communicate, advocate, and empower to shape the outcomes for injured workers. WORKERS’ COMPENSATION UNIT MANAGERS ARE CONFIDENT We know who we are, and we allow our team to thrive by being their very best selves. We are not afraid to be ourselves because the more authentic we can be the better work we can do to help injured workers by building trust and transparency throughout the workers’ compensation journey. We do not follow trends; we create them. We inspire for others to thrive. WORKERS’ COMPENSATION UNIT MANAGERS ARE DETERMINED We are focused on making good things happen for people and persistent in following through with what we say we are going to do. We help our teams push through fears to help injured workers with the unknown to emphasize the importance of being a recovery team. We understand failure is just a pathway to success to continue to move the workers’ compensation industry forward. WORKERS’ COMPENSATION UNIT MANAGERS ARE KIND We are ambitious and driven to make good things happen for our teams, injured workers, and the industry. We use our power to empower others. Together we can shake up the workers’ compensation world. We understand the ripple effect and how each decision, each encounter, each conversation impacts the greater whole. 2 3

C T on able o t Workers’ Compensation en ts f Claims Specialists Credo Workers’ Compensation Claims Specialists are extraordinary leaders of injured workers, NARS W formulating optimal plans of recovery to get people back to work, back to life! a y WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE U W nit MC C anagr PASSIONATE edo f We are energetic and curious. We love life and actively craft it to create happiness within eror ourselves as well as our injured workers. We help injured workers with recovery and goals. s f WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE orW SC C pecialistsr CREATIVE edo We celebrate the individuality of our injured workers and of ourselves. That is what makes us special and unique! We are the change agents. The trailblazers. We have a desire to advance workers’ compensation culture and create a new reality for the world to follow. P r acticB WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE es est INNOVATIVE We embrace technology to advance the workers’ compensation industry. We embrace a new U way of thinking about injured workers to create, connect, and push the industry forward. We Checklistnit M shape the way workers’ compensation speaks, advocates, empowers to live, work, and thrive. anag er WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE ChecklistSW CONFIDENT pecialist C Claims We know who we are. We are not afraid to be ourselves. We do not follow trends; we create them. This allows us to be our very best selves for our injured workers and for our clients. We inspire for others to thrive. WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE 14 DExpecta F a tionsile y DETERMINED s We are focused and persistent to push the needle forward for the very best treatment of our injured workers, yielding the best outcomes. We push through fears and help injured workers understand the unknown to Expecta focus on reality. We change the process to improve understanding and consumption of a complex system. F WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE tionsile R e KIND f er D We are ambitious and driven to make good things happen for others. We use our power to empower encisability others. Together we can shake up the workers’ compensation world. We understand the ripple e G effect and how each decision, each encounter, each conversation impacts the greater whole. uide CaN We are...Workers’ Compensation Claims Specialists t o egt And we are here to change the workers’ compensation industry. orieses and 2 3

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES North American Risk Services, Inc. – The Workers’ Compensation Claims Team adopts these “Best Practices” for Claims as a framework for good faith claims handling, understanding that each claim is unique, the industry is dynamic, and business requirements continually change. NARS – WC Team will continually review and assess these “Best Practices” to assure its position as a superior provider of claims services to its customers. CUSTOMER EXPERIENCE: • Being the best company at customer experience is what separates NARS – WC Team from all other third-party administrators. Our mission is: • Establish timely and substantive initial contact. • Make timely and substantive follow-up contacts. • Communicate timely, substantively, clearly, and professionally. • Utilize, manage, and respond to written correspondence, e-mail, telephone contact, SMS texts and chat timely and professionally. • Promptly investigate, analyze, and fairly resolve claims. • Meet the needs of customers by responding to special requests. • Address the needs of the employer. • Develop and employ processes and technology that support superior service. • Protect privacy of information with respect to agents/brokers, employers, injured workers, and the NARS. • Substantive means: • An exchange of information that keeps the client informed and brings the claim to a timely disposition. • Establish mutually understood expectations with all parties during the initial phase of the claim evaluation. • Manage those expectations throughout the life of the claim. COVERAGE: • Identification of all potentially applicable coverages is a critical step in fulfilling our contractual obligations to our clients. • The subsequent analysis and application of coverage to the facts of the loss is the foundation upon which a claim is appropriately resolved, and sound evaluations and decisions are made. • The coverage evaluation process includes identification and analysis of: • applicable coverage forms • the relevant insuring agreement and policy provisions • all endorsements which may apply and serve to enhance or restrict coverage • applicable coverage limits • deductibles • co-insurance • available excess coverage • documentation to support analysis 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 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

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

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES • Company resources are utilized to establish or confirm claims exposure. • Sufficient exposure documentation in the file is maintained to support the appropriateness of exposure analysis and evaluation. RESERVING: • Reserves reflect an evaluation of the total exposure to the employer/insurer based on all known information, and the anticipated ultimate probable outcome of the claim at a given point in time. • The WC Claims Specialist establishes reserves after the issues of coverage and exposure have been identified, investigated, documented, and evaluated. • Reserves are established by the WC Claims Specialist within 7 days of assignment of the claim based on information developed, analyzed, and evaluated in the initial stages of the claim. • Initial reserves should be reviewed by the WC Claims Specialist as soon as possible for each exposure, from the initial notice of loss to the company. • Reserve changes made necessary due to changes in condition or additional information are accomplished by the Workers’ Empowerment Specialist as appropriate. • A loss reserve is not to be equated with an amount that will necessarily be offered to settle a claim. The settlement process is separate from the reserving process, as settlement is subject to negotiation and other variables. LEGAL EXPENSE RESERVING: • Timely and accurate expense reserves are maintained on litigated claim files subject to client and/or management approval. • The WC Claims Specialist will request defense counsel to provide a litigation budget and legal action plan. • Throughout the life of the litigated file the WC Claims Specialist should review the expense reserve for adequacy, accuracy, and consistency with the approved litigation budget. • Paid litigated expenses should reduce the expense reserve in accordance with the litigation resolution plan and corresponding budget that has been approved. Any acceleration in paid expenses relative to the budget should trigger a review of the approved litigation budget for adequacy and accuracy and the budget proactively modified as required. DOCUMENTATION: • All notes to the file should strive to be objective, clear, concise, factual, and relevant to the claim. • The documentation and reporting allow the file to “speak for itself,” in a manner that tells the story of how the claim has progressed and is moving forward. 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 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 6 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties. 7

C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation BEST PRACTICES NARS W a • File documentation is accomplished primarily via Claim Notes and appropriate utilization of Note Types as well as y posting pertinent correspondence, reports, and other materials to the claim including but not limited to medical reports, medical bills, and nurse case management documentation. U W nit MC C anagr • File reporting is an ongoing process and is consistently and timely updated as new information develops. edo f er or • Reports are utilized in compliance with company guidelines and include but are not limited to Large Loss, s Reinsurance, Pre-Trial and Trial. f or W S C C STATUS REPORT: pecialistsr • A Status Report includes an identification of the critical/unresolved issues regarding Coverage, Compensability, edo and Exposure, and the investigative tasks to be completed to resolve each critical/unresolved issue that leads the WC Claims Specialist to develop an evaluation of Coverage, Compensability, and Exposure; and move the claim to P r disposition, resolution, and/or negotiation. acticB es est • The WC Claims Specialist’s Status Report is a clear, concise, and pro-active approach to bringing the claim to a fair and timely resolution. U • The Status Report is dynamic, reflecting the strategies for fairly resolving the critical/unresolved issues as additional Checklistnit M information is developed and analyzed. anag EXPENSE MANAGEMENT: er • The North American Risk Services, Inc. – WC Claims team strives to avoid even the slightest appearance of ChecklistSW impropriety when facing actual or potential cases of conflicts of interest by maintaining “arm’s length” relationships pecialist C Claims with vendors, independent adjusting firms, attorneys, and others with whom it does business. • WC Claims Specialists are responsible for exercising reasonable business judgment in the selection, retention, and management of external resources to facilitate fair and prompt resolution of claims. Expecta 14 D F • Scopes of assignments to external resources should be specific and limited to assure appropriate expenditures, and a tionsile y sufficient to provide good faith investigation, analysis, and resolution of claims. s Expecta F tionsile R e f er D encisability e G uide 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 6 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties. 7

WORKERS’ COMPENSATION UNIT MANAGER CHECKLIST Initial File Collaboration Explanation Coverage Timely Initial Contacts – 3 Point If cannot make contacts, contact leader Review Initial Investigation/Employer Confirmation of accident, injury and body part, wit- nesses, recorded statements, advise employer to stay in contact with employee. Contact W/Provider If able, confirm description of injury/accident given, body part, last and next appt, and work status Contact W/Employee Recorded statement, confirm accident description, confirm lost time dates, confirm all body parts injured, last appt and next appt, explain expectations/benefits, document a profile, discuss rtw expectations and prior injuries Subrogation Referral Is there recovery potential? Double Check Jurisdiction Class Code Compensability Decision Agree? Need any further investigation? Plan Of Action Elements Review all elements. Medical Records Requested? Work Status Received/Confirmed RTW Screens First Pay Due Date Back? Wage Statement Received? Benefits Calculated Correctly And Documented? Job Description Requested From Employer Job Description Sent To Provider RTW Projection Form May not need or be able to use Surgery Form May not need or be able to use Need For SIU? Nurse Case Management Needed? Medicare? HICN ORM Assumption Completed? ISO Always Comment On Reserves Form Work Completed the initial form work? Workers Empowerment Collaboration Review Explanation – Subsequent Status of the file? Check ongoing payments and calculations, work status Reserving appropriate? Following handling instructions and do reserves accu- rately reflect exposure? Pay attention to initial reserves, ensuring it reflects exposure. continued on page 9 8 9

C T onable o t en WORKERS’ COMPENSATION tsf UNIT MANAGER CHECKLIST (CONTINUED) Action Plan? Managing medical and disability forward? Are target NARS W dates updated and following projections? What is the a plan to move to resolution? Are we communicating with y the injured worker and employer on updates? UW Daily/Weekly nit MC C Release Payments anagr Release Reserves edo f eror Review Pending Medical Bills Let’s strive to be less than 5 days overdue. s f orW SC C pecialistsr Review Criteria: edo 1. Quality care of the injured employee – Are they communicating with the employee? Are they providing the benefits information? Advising they P r will be receiving a packet? If so, when was the last time they spoke with the employee? Did they note acticB discussion of target dates for RTW/MMI projections and potential resolution? If a litigated file, are they esest holding the employees and/or their attorneys accountable for their own recovery, empowering them? U 2. Outcome – Checklistnit M What is the probable outcome and when and how will we get to it? Let’s use the word outcome in the file. Drive to recovery and RTW, that’s our successful outcome. Specialists need to get comfortable with anag the idea that we are looking for them to take care of the injured worker while looking for the best quality er and best cost-effective outcome on the file. ChecklistSW 3. Closure – Resolution – Settlement – pecialist C Claims Help specialists focus on their monthly production rate, close what they can by the end of the month. We don’t want to re-open a file, so closures need to be appropriate. We need closure letters or calls to the injured worker and employer. Just a call to let the parties know all has been taken care of. If permanent disability is a potential, we need to see a pricing evaluation in the file under the action plan, 14 DExpecta so all parties are aware of the value of the case. While fully taking care of the injured worker, need to F a tionsile stay focused on inventory reduction (when appropriate) for settlement and closure rates. y s 4. Target Dates – Do not be afraid to post a date you expect them to accomplish something…accountability. Injured Expecta workers need a goal to work for. Challenge them to be bigger and better than ever. F tionsile R e f erD encisability e G uide CaN t o egt orieses and 8 9

WORKERS’ COMPENSATION CLAIMS SPECIALIST 14-DAY CHECKLIST Initial File Collaboration Explanation Coverage Confirm coverage, employee and state is covered. In-force- Policy? Use your C3 policy search. Timely Initial Contacts – 3 Point If cannot make contacts, contact leader. MISSED CONTACT IS UNACCEPTABLE. Review Initial Investigation/Employer Confirmation of accident, injury and body part, witnesses, recorded statements, advise employer to stay in contact with employee. REQUEST WAGES AND JOB DESCRIPTION. Check injury codes, etc. for accuracy. Contact W/Provider If able, confirm description of injury/accident given, body part, last and next appt, and work status Contact W/Employee Recorded statement, confirm accident description, confirm lost time dates, confirm all body parts injured, last appt and next appt, explain expectations/benefits, document a profile, discuss RTW expectations and prior injuries Subrogation Referral Is there recovery potential? Jurisdiction Verify Class Code Verify Confirm Work Comp Type Mo/Ind. This should be changed on the summary screen. Compensability Decision Agree? Need any further investigation? Document. Losing Time? MARK FILE Medical Records Requested? Work Status Received/Confirmed RTW Screens Complete First Pay Due Date? Document file. Wage Statement Received? Benefits Calculated Correctly And Documented? Job Description Requested From Employer Job Description Sent To Provider Medical Treatment Plan/Fill In RTW Projection Form May not need or be able to use Surgery Form May not need or be able to use Need for SIU? Nurse Case Management Needed? Medicare? HICN ORM Assumption Completed? ISO Should be sent by outbound team. Initial Reserves Must outline most probable outcome Form Work Completed the initial form work? Be specific when needed. Reserving appropriate? Following handling instructions and do reserves accurately reflect exposure? Pay attention to initial reserves, ensuring it reflects exposure. 10 11

C T onable o t en WORKERS’ COMPENSATION CLAIMS SPECIALIST tsf 14-DAY CHECKLIST (CONTINUED) 1. Quality care of the injured employee- NARS W • Are you communicating with the employee? a • Are you providing the benefits information? y • Advising you will be receiving a packet? • When was the last time you spoke with the employee? U W • Did you note discussion of target dates for RTW/MMI projections and potential resolution? nit MC C anagr • If a litigated file, are you holding the employees and/or their attorneys accountable for their own recovery, edo f empowering them? er s or 2. Outcome – f • What is the probable outcome and when and how will we get to it? orW SC C • Let’s use the word outcome in the file. pecialistsr • Drive to recovery and RTW, that’s our successful outcome. edo • You need to get comfortable with the idea that we are taking care of the injured worker while looking for the best quality and best cost-effective outcome on the file. 3. Closure – Resolution – Settlement – P r acticB • Focus on closing files appropriately. Set a day of the month to review closures. esest • We don’t want to re-open a file, so closures need to be appropriate. Call or send a closure letter to the injured worker. Just a call to let the parties know all has been taken care of. If permanent disability is a potential, we need to see a pricing evaluation in the file under the status report, so all parties are aware of the value of the case. U While fully taking care of the injured worker, need to stay focused on inventory reduction (when appropriate) for Checklistnit M settlement and closure rates. anag 4. Target Dates – er • Always use target dates on your actionable items to keep moving the file. Injured workers need a goal to work for. Challenge them to be bigger and better than ever. W ChecklistS pecialist C Claims 14 DExpecta F a tionsile y s Expecta F tionsile R e f erD encisability e G uide Ca N t o eg t orieses and 10 11

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS 14-DAYS COVERAGE Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Items to check or paste to the file if all apply: • Search and reload completed and coverage confirmed. • The policy number has been confirmed. • The loss did occur within the policy period, and the Jurisdiction is covered. • There has been no breach of any policy condition • No policy exclusions apply • No individual, corporation, or partnership considerations apply • There is no concurrent jurisdiction. • There is no deductible, or There is a deductible • Any reason to send a risk alert? Example Note: The injured worker is not covered under this policy as it is written only to cover clerical staff versus the trucking staff. Coverage has been verified upon review of the policy for workers’ compensation, as Green Electronics does have a current policy for all staff. The injured worker has been verified as an employee by Green Electronics. ***If no coverage, please state clearly why and next steps for the claim. INITIAL INJURED WORKER CONTACT Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Medical only Template: Called the injured worker and introduced myself as the contact for any future needs related to this workers’ compensation claim. Provided my contact information. Also sent a letter out. (Client Specific) Template: Claim does not warrant injured worker contact currently. It is a medical-only claim with no questions of validity from the insured or claim specialist. (Client Specific) Template: This is an incident-only claim, and per the client’s instructions, no contact was made with the injured worker. ***The following template includes essential questions. Please refer to your injured worker statement for a more thorough investigation. (see next page) continued on page 13 12 13

C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W 14-DAYS a Verify the name, age, date of birth, SSN, address, the telephone is correct in Claims System y U W • Confirm the accuracy of the Big Five Data elements during contact with the employee: nit MC C Employee Social Security Number: Verified anagr Date of Birth: Verified edo f Gender: Verified eror First & Last Name: Verified s Address: Verified f orW • Telephone SC C • Height/weight: pecialistsr • Languages spoken: edo • Marital status: • Dependents: • Education & what level: P r • Other training & certificates: Hobbies: acticB • Employer’s name & location: es est • Date of hire/Length of employment: • Supervisor name & title: • Work hours and days worked: U • Wage information: Checklistnit M • Any other current jobs or income: anag • Prior employment history - Employer’s name/ your title/date of employment/ job duties: er • Current job description/duties: • Medical history: • Accident time/date/place: ChecklistSW • To whom and when was injury reported: pecialist C Claims • Witnesses: • How did the injury occur: • Symptoms at the time of injury: • Body parts injured: 14 DExpecta • Date of first treatment: F • Where is IW treating: a tionsile y • Current symptoms: s • Diagnosis: • Next appointment: Expecta • Referred to the doctor by an employer: F • Prior injuries to any body parts to include personal or work-related: tionsile • Was the damage due to a machine, equipment, or another person? If so, obtain details: • Have you RTW? R e If so, full or transitional duty: f erD • Last day worked/the First day of lost time: encisability • Group/health insurer: e G • Medicare beneficiary or applied for SSDI and Medicare: uide • Benefits explained to IW: • Pharmacy card explained to IW: • Preferred Method of Contact? CaN t o egt orieses and 12 13

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS 14-DAYS EMPLOYER INITIAL CONTACT Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Template • Contact name/title: • Employee supervisor: • Job description/duties: • How long on this job? • Prior claims? • AWW: • Wage statement requested: • Injured employee date of hire: • When accident reported/to whom: • Was the employee drug tested? • Date employee began losing time: • Paid wages on date of injury? • Wages continued by the employer? • Modified duty return/full duty return to work? • Modified duty available? • If there is no modified duty, consider transitional duty? • Injury description: • Treatment: • Med provider(s): • Directed/panel? • Subrogation potential: • Witnesses: • Any reason to doubt the validity of the claim? • Recorded on video surveillance? • Date of loss: • Time of loss: • Preferred Method of Contact: Email to send to the employer requesting the above information: Here is the list of questions for you to answer. Also, if you have any documentation about this injury, please fax those to the number listed below. Documentation includes your internal First report of injury, safety investigation, medical note(s), work slips, etc. Your help is greatly appreciated. 14 15

C T onable o North American Risk Services, Inc. t en tsf Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W 14-DAYS a MEDICAL PROVIDER/MEDICAL MANAGEMENT y U W Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. If nit MC C medical information is unavailable, document the medical is unknown but update the file as soon as it is received. r anagedo f Template eror s • Date of Visit: f orW • Physician’s Name: SC C • Physician’s Telephone Number: pecialistsr • Clinical Diagnosis: edo • ICD9/ ICD 10 Code: • Treatment Plan: • Referrals: P r • Work Status: acticB • Restrictions (if any): esest • Next Appointment Date U Example Checklistnit M Date of visit: 5/1/21 anag er Physician’s Name: Dr. John Smith Hospital: Mercy Hospital Telephone Number: 309-221-2200 ChecklistSW Clinical Diagnosis: Low Back Strain pecialist C Claims ICD 9/ICD 10 Code: Treatment Plan: Recommending physical therapy 3 x week for 4 weeks, NSAIDS, MRI of the lumbar spine, FU in 6 weeks (include date). Work Status: Completely off work, first full day off 4/20/21 14 DExpecta Restrictions: No work F Next Appt. Date: 5/15/21 a tionsile y *ATTACH MEDICAL RECORD TO NOTE. s Expecta F tionsile R e f erD encisability e G uide CaN t o egt orieses and 14 15

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS 14-DAYS WITNESS Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Template • There were no witnesses to the injury Template • First Name: • Last Name: • Address: • Telephone: • Job title/duties: • Accident time/date/place: • What did you witness: SUBROGATION Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Template • Subrogation potential rationale: There is no subrogation potential as no third party was involved. Template • If subrogation potential, is there a third party involved that may share in the responsibility for this loss? • If so, please describe their involvement and possible negligence. Include the carrier’s name, type, coverage scope, and limits for the responsible 3rd party. • If subrogation potential, evidence preservation requirements. • State of Jurisdiction: • Does the Jurisdiction have SIF (Second Injury Fund): • Evaluation of Potential for SIF Recovery: 16 17

C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W 14-DAYS a COMPENSABILITY y U W Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. nit MC C anagr Abbreviated Template edo f eror • Under investigation: Currently, compensability is pending. Need to secure employer and/or injured worker’s s f statement. Compensability will be updated once the investigation has been completed. orW SC C Full Template pecialistsr edo • Jurisdiction: • Employment Description: • Accepted Body Part(s): P r acticB • Accident Description: es est • Diagnosis: • Causal Relationship: U Example: Rationale for Compensability Checklistnit M The injured worker did meet the definition of an employee and was in the course and scope of their employment when anag injured. The injured worker is eligible for workers’ compensation benefits. (Do not use the word DENY…eligible or not er eligible) ChecklistSW OPTIONAL: You can add what the injured worker was doing when injured if you want. pecialist C Claims EX: Injured worker was stocking the liquor shelves and received a laceration for the webbing between her ring finger and the pinky finger. Two examples: 14 DExpecta F a tionsile This file is eligible for benefits under workers’ compensation. The injured worker is a janitor who was mopping the y school floors when she turned and heard a pop in her back, sustaining a low back injury to the L5-S1 level. As the s injured worker was in the course and scope of her employment with Brookview Elementary by performing janitorial duties on-site, this file is accepted as compensable under Nebraska Workers’ Compensation. Expecta F This file is not eligible for benefits under Iowa jurisdiction based upon the idiopathic condition as the injured worker tionsile fainted while walking down the hallway at work. The syncopal episode is related to the injured worker’s health condition and not her employment. The file is not eligible for workers’ compensation benefits under Iowa Workers’ Compensation. R e f er D *If the employee is not eligible for benefits, please make sure there is authority from a leader on file to notify of the encisability ineligibility of benefits. e G uide CaN t o egt orieses and 16 17

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS 14-DAYS WAGE BENEFITS Expectation: Due by the 14th day from the date reported. Copy and paste the template into the file and fill it in. Templates • For incident or medical only: No lost time or wages. TTD/TPD/PPD/Settlement If estimating the wage rate, document and justify the estimated rate with the calculation in the note AWW: $1,000.00 S-1 W/C Rate: $674.00 Jurisdiction: Iowa AWW calculated taking the 13 weeks before the DOI (04/14/2020), totaling $7,475. $7,474.00 / 13 = $575.00 AWW: $575 X 2/3 W/C Rate: $383.33 If losing time and being issued TPD: TPD for the week of 11/01/2020 – 11/07/2020: Injured worker worked a total of 14 hours. 14 hours x $15.00 = $210.00 AWW: $575.00 $575.00 - $210.00 = $365.00 $365.00 x 2/3 = $243.33 TPD issues for the week of 11/01/2020 – 11/07/2020 in the amount of $383.33. TPD is set for the next six weeks (11/01/2020 – 12/12/2020) for the weekly amount of $383.33. PPD is being issued for the impairment to the right shoulder because of the arthroscopic surgery. Impairment total 5%; 5% x 250 weeks = 12.5 weeks x $674.00 = $8,425.00. PPD is issued from 05/08/2020 to 08/03/2020 for 12.5 weeks of benefits at $674.00. *Were statutory defenses considered – for example, safety infractions. (Jurisdictionally specific) **Attach documentation! 18 19

C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W 14-DAYS a INITIAL – INTERIM- STATUS REPORT y U W Expectation: Initial Status Report is due by the 14th day from the date reported. Copy and paste the template into the nit MC C file and fill it in. anagr edo f Interim Status is due Day 30. Copy, paste and change what is necessary. eror s f Regular Status Reports are due every 45 days for lost time cases. Change what is needed, every 60 days for medical only orW and 90 days for permanent disability cases. SC C pecialistsr Template edo • Jurisdiction: • Summary of injury: P r acticB • Medical treatment: es est • Work status: • Benefits owed: • Disability management: U • Legal status: Checklistnit M • Goal: anag Strategy: er 1. Maintain contact with all parties (Ongoing: injured worker and employer) 2. Review/ Set reserves (Ongoing) (7 days) W ChecklistS 3. Manage medical to projected MMI date of (Target date) pecialist C Claims 4. Obtain release to work (Target Date) 5. Pay all related bills (Ongoing) 6. Settle/resolve the claim (Target Date) 14 DExpecta F a tionsile Pricing Evaluation and Negotiation Plan: y (Category: Resolution Plan, NOT status report) s • Pricing Evaluation and Negotiation Plan: • PPI Rating: Expecta • MSA: (Y or N) if yes, plan of action F • Reserves Appropriate: (Y or N) tionsile • Negotiation: • Explain numbers and rationale for negotiation. Also, explain clearly why an attorney negotiated the file instead of the specialist. R e f erD encisability e G uide CaN t o egt orieses and 18 19

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS 14-DAYS MEDICAL ONLY STATUS REPORT Expectation: Due by the 14th day from the date reported. Follow up with status report is expected every 60 days thereafter unless treatment warrants otherwise. If the injured worker did not lose time from work and we are paying medical bills only, the following can be used for a status report at all levels. It is a medical-only claim with no questions of validity from the insured or claim specialist. Once bills are processed, file will be closed. Target date: *If you are managing treatment, the expectation is to follow lost time guidelines for contacts and status reports. LITIGATION Expectation: Due by the 14th day from the date reported, if applicable. If no litigation, add upon receipt of attorney representation. Copy and paste the template into the file and fill it in. Example note for no attorney: This claim is not litigated at this time. The injured worker is not represented. If litigated: Plaintiff attorney is Defense attorney is If referred to counsel, the specialist is responsible for sending the file with a summary to defense counsel. Example file note: Received legal plan of action and budget from Defense Counsel. The budget is $25,000.00 and is set to include: deposition, etc. Defense counsel values this file at the present time in the range of 20-30% based upon the nature of the injury and the location of the injured worker. Suggestions for further workup include obtaining an IME and scheduling the injured worker’s deposition. Legal review with Muselman Law Firm. We discussed extending authority up to $25,000.00 as we are looking to resolve this Iowa claim with an Agreement for Settlement. Will follow up with defense counsel in two weeks to determine the status of settlement negotiations. *Complete Litigation Module – Send diary to CSR to add defense attorney to Bottomline/Legal X. Leaders are required to review the following and document a note to the file: • Hearing Notices • Settlement/Evaluations, as needed for training • CMS Liens 20 21

C T onable o North American Risk Services, Inc. t en tsf Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W a EDI/STATE FILINGS y UW Expectation: All form-work should be completed by the specific jurisdiction time frame. All EDI requests should be nit MC C completed within 48 hours of the requirement. EDI is required to have form-work completed within 48 hours of the anagr request. edo f eror Example: (just one line of the specific form) s f orW • Filed FROI with State of Iowa 11/08/2020. SC C • IP filed with State of Iowa on 11/10/2020. pecialistsr • S1 filed with State of Iowa on 11/14/2020. edo • FN filed with State of Iowa on 11/30/2020. *Attach document. P r acticB esest MEDICARE • Is the injured worker a Medicare recipient? U • Fill in the information on the Medicare Tab under the Injured Worker tab on the tree. Checklistnit M • Fill in HICN #. anag • ORM Assumption Date (Check ORM Accepted): If the claim is or is projected to be greater than $750 in medical. er • Choose ICD Codes from your list. • See Closure for requirements for Medicare when closing a claim. S W Checklistpecialist C Claims Note Example if a conditional payment notification is received: The injured worker is a Medicare recipient with HCN: 45324A432. The file has now been settled. TPOC entered on 11/08/2020. 14 DExpecta F Conditional Payment Notification received. Information was sent to (Cattie & Gonzalez) to assist in the lien. a tionsile y Received Conditional Payment Ledger for $24,000.00. s *Must notify your leader, and the leader must document acknowledgment and agree with the direction. Expecta F tionsile R e f erD encisability e G uide CaN t o egt orieses and 20 21

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

C T onable o North American Risk Services, Inc. t en tsf Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W a DISABILITY MANAGEMENT y U W Expectation: A disability management plan is due by the 30th day from the date reported. nit MC C anagr See Disability Management Guide edo f eror Disability Management works hand in hand with medical management. The Disability Management Guide walks through s f the steps of managing disability. Every file should demonstrate the ability to aggressively manage disability with the orW engagement of the injured worker and the employer. SC C pecialistsr INVESTIGATION edo Expectation: A compensability decision is made by the 30th day, if not by the 14th day. These elements are necessary by the 30th day, at the latest. Document any findings during the life of the file. P r acticB ISO and Red Flags - Example esest ISO report returned five hits. The injured worker was previously involved in four other workers’ compensation claims U which Travelers handled. The request is being made to obtain information for these ISO hits. The fifth hit is for an MVA Checklistnit M through State Farm. Information requested. anag ISO returned two hits. One is not for the injured worker but for someone with a similar name. The other is for the injured er worker’s daughter. ISO report okay, and no further information is needed at this time. ChecklistSW Belleview Police Report received. Our injured worker was at fault. Third-party information obtained: Joe Smith, 43, pecialist C Claims Allstate policy, etc. They were forwarded to NARS Subrogation Unit. Social Media scrub resulted in a hit indicating the injured worker was skiing based on his Facebook profile the weekend before reporting his employer’s compensation injury. Expecta 14 DF a tionsile VOCATIONAL REHABILITATION y s Expectation: Document the file as noted below. Copy and paste the template into the file and fill it in. Template Expecta F tionsile • Not anticipated at this time. R Template e f • Vendor for VR: erD • Does the client approve the service? encisability • Rationale: e G uide CaN t o egt orieses and 22 23

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS ONGOING SUBSEQUENT COMMUNICATION Expectation: Update the employer every time there is a significant change in the file/status report to include the return-to-work process. Injured worker: For lost-time claims, communicate with the injured worker every 14, 30, and 45 days. • A significant change in the file • Return to work coordination • Following an appointment • Following a surgery. Send cards, flowers, etc., following a surgery. Example of communication following a surgery: A telephone call to injured worker: (123) 456-7890. Checked in to see how things were going post-surgery and reiterated benefit discussion explaining how the rate was calculated, how often benefits would be issued, and that we will continue to contact after medical appointments. Provided contact information for her to reach me should she need anything in the meantime. (INJURED WORKER) A telephone call to Barry with Green Electronics (234) 445-6789. Informed Barry that Sarah is doing well and discussed potential modified duty options for return-to-work once a release is obtained. I reminded Barry to reach out to Sarah to check in on her while off work. (EMPLOYER) Sent get well/thinking of you card to the injured worker. Text message. SECOND INJURY FUND Expectation: Document the file as noted below and as applicable. Copy and paste the template into the file and fill it in. Template Not applicable – There is no second injury fund potential for the employer, insurer, or TPA in this state. The second injury fund is available to the injured worker only, and it is the injured worker’s responsibility to pursue, if applicable. NURSE CASE MANAGEMENT Expectation: Document the file upon hiring either a telephonic or field nurse case manager to assist with medical or disability management on a file. Explain rationale. 24 25

C T on able o North American Risk Services, Inc. t en ts f Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS NARS W a UNIT MANAGER REVIEW – CATEGORY – MANAGERIAL NOTE y U W Expectation: Due by the 15th day from the date reported. Copy and paste the template into the file and fill it in. nit MC C anagr Use a 15-day checklist: edo f • Confirmed date of loss? eror • Confirmed Jurisdiction? s f • Date Reported: orW • Coverage Verified? Accurate? SC C • Complete Class Code? Accurate? pecialistsr • Injury Codes Confirmed: (Y or N) Accurate? edo • Linked Claim – N/A • Agree with Compensability decision: (Y or N, Explain) • Completed Contacts? (Y or N) (IW, ER, PR) P r acticB • Injury/Description of Incident: es est • Diagnosis: • Treatment: • Work Status documented? • Job Description sent to the provider? U • Document First Full Day Off? Checklistnit M • Document Waiting Period? anag • Document rate of pay. Correct? er • Completed forms? (Y or N) • Payment Due: • Legal: N/A ChecklistSW • Make subrogation referral? (Y or N) pecialist C Claims • Are reserves set? Accurate? • Completed claims system (Y or N) • Agree with medical and disability management: • Action items for adjuster: 14 DExpecta F SUBSEQUENT UNIT MANAGER QUALITY CLAIM MANAGEMENT REVIEW (QCM) a tionsile y s Expectation: Due at the 30th day from the date reported and then every 60 days from that date. Copy and paste the template into the file and fill in. Expecta F Template tionsile • Summary: • Reserves: • Recommendations: R e f er D encisability e G uide CaN t o egt orieses and 24 25

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE DOCUMENTATION EXPECTATIONS SPECIAL INVESTIGATION UNIT Expectation: Document the file upon referring the file to the special investigation unit. Example of note: Referral made to NARS SIU. VENDOR Expectation: Document the file upon referring the file to a vendor. *If using a vendor for medical management (except nurse case management), put a note in the file under the category Medical. This is required for all vendors. Example note: Assigning Streamline to the file to coordinate diagnostics for the injured worker. Our client, name, approved Streamline on 3/22/21. • If investigation vendor, the category is investigation. CLOSING NOTE Expectation: A closing note is required prior to closing a lost time file. Must communicate with the injured worker and employer upon closure of a claim. (If there is no initial communication with the injured worker, no closing communication is required.) Confirm the following before closing: (copy and paste into the file as a closing note). • The injured worker has been discharged from medical care and placed at MMI. • No future medical treatment is needed. • Any lost time has had indemnity payments issued, and notices sent timely. • It is confirmed that the outstanding medical billing has been paid. • Verified that all applicable state forms and EDI have been submitted if applicable. • The claim doesn’t involve a Medicare beneficiary. • The claim is resolved. • Legal bills paid. • Closing the file this date. AUTHORITY/AUTHORITY REQUESTED Example of note: The injured worker was involved in a fatal accident. According to account handling instructions, this is considered a significant loss and has been reported to Joe at the customer on this date. 26 27

C T on able o t en DISABILITY MANAGEMENT REFERENCE GUIDE ts f Purpose This document summarizes key issues pertaining to disability management. NARS W Resources for Disability Nurse Case Manager – Field or telephonic nurse and Medical Protocols IME / Second Opinion a Other Programs / Resources – Activity Checks, Surveillance, Vocational y Rehabilitation U W Resolving Discrepancies • Specialist must recognize and address discrepancies in type and duration of nit MC C anagr Between Protocols and treatment. Nurse Case Manager referral needed? edo f Physician’s Plan • Specialist must understand injury and treatment issues. eror • Use resources as needed (see prior section) to comprehend complex/unusual/ s comorbid issues and/or communicate with provider. f orW • Challenges to treating physician must be based on medical knowledge SC C • Final decision rests with treating/IME physicians. pecialistsr • Specialist must post results of any discrepancies. edo • Specialist must also identify and resolve any discrepancies between verbal information and any subsequent written documents. P Job Descriptions • Job descriptions should be requested at case creation. r acticB • Specialist is responsible to follow up for job descriptions until received (Initial es est Contact, First Payment, 30 Day Review of file). • Job descriptions (regular and modified) must be sent to physician’s office and attached to patient’s chart before next appointment. U • Specialist should send cover letter/sheet with job descriptions, so provider Checklistnit M knows why the description was sent and fact that employer is committed to anag returning employee to work (modified and regular duty). er • Persistence is key if physician is not responsive (follow-up consisting of combination of fax and phone calls may be needed). W ChecklistS • Use resources (Field Nurse, Job Task Video) if employer unable to provide pecialist C Claims written description. IME/ Second Opinion • Specialist must select credible physician within appropriate specialty. • Nurse Case Manager and defense attorneys are resources. • Obtain necessary records, films and any other documentation needed prior to 14 DExpecta IME exam. F • Prioritize and summarize records for physician. a tionsile y • Specialist should ask specific questions, including those needed to address any s discrepancies between protocols and treating physician’s plans. RTW Adjustments • Specialist must maintain ongoing communication with employee after Expecta modified/TAW RTW. Partial disability is still a form of disability and specialist’s F obligation extends through regular duty RTW, even if no TPD is owed. tionsile Specialist must also adjust payment instructions to prevent improper payment of benefits. R e • If the employer does not have TAW and the jurisdiction allows, the case f erD handler should look to involve transitional work. encisability e G continued on page 28 uide CaN t o egt orieses and 26 27

DISABILITY MANAGEMENT REFERENCE GUIDE (CONTINUED) Target Dates • Specialist must obtain both modified and regular duty target dates. • Specialist must obtain revised target dates as needed. • Include modified and regular duty target date questions on letter/sheet faxed to the physician’s office prior to appointment. • Persistence is key if physician is not responsive (follow-up consisting of combination of fax and phone calls may be needed). • Use resources as needed (see prior page) to help obtain target dates. • If physician unwilling to provide estimated return to work dates (modified and regular) Use Ongoing Disability Guidelines • Investigate any discrepancies between guidelines and physician’s plan. Determine impact of any employee profile/comorbid issues. Post results. Note: Target dates are the probable return to work dates based on medical condition and type of work performed. A target date is not merely the next appointment date. • If the employer does not have modified/TAW available, the specialist should post file with specific reasons why work is not available. Specialist should also post confirmation of discussions with employer, employee, and provider regarding benefits of modified/TAW. • Specialist must communicate initial and revised target dates to employee and employer. It is important to speak with employee and not just leave messages. Specialist should send a letter to employee with copy to employer if unable to contact employee after two (3) consecutive days of effort. Post the full name and date of contact for all communications relating to target dates. Specialist must explain any delays in communicating target dates to employee. Status Report • Specialist must include disability management strategy within plan. • Specialist must adjust action plan based on changing facts. • Specialist should develop contingency plans to counter case handling obstacles. • Specialist must post detailed reasoning for any decisions made to not complete specific tasks relating to management of disability or medical issues. 28 29

C T onable o North American Risk Services, Inc. t en tsf Workers’ Compensation CLAIMS FILE NOTE CATEGORIES & CONTENT NARS W a Authority y Authority granted by client and/or NARS leadership. UW nit MC C anagr Authority Requested edo f Authority requested of client and/or NARS leadership. eror s Compensability f orW Acceptance, denial, or deferral of the claim, jurisdiction, and justification. SC C pecialistsr Contact edo Communication with Injured Worker and Employer, determined by filter. Injury cards, birthday cards, anni- versary cards documented if sent. Statements from the injured worker. P r acticB Coverage esest Analysis of the coverage applicable to the workers’ compensation line. EDI/State Filings U State form filings including what was document was filed, what date it was filed, status, and next filing. Checklistnit M anag Investigation er Police reports, ISO reports reviewed. Currently an “ISO Report Completed” comes back into the file which is an automated system note. This is what the adjusters do with it. W ChecklistS Large Loss Report pecialist C Claims Client notification for reserves, payments, settlements. Litigation 14 DExpecta All legal correspondence including budget, plan of action, an assessment. F a tionsile y Managerial Notes s Workers’ Empowerment Leader Notes. Claim assignment information upon leadership review. Medicare Expecta F Medicare information, filings, and correspondence. tionsile Nurse Case Management R Case Management Updates/Correspondence. e f erD encisability Pharmacy e G Pharmacy Benefit Manager approval/rejection with commentary as needed. uide CaN t o egt continued on page 30 orieses and 28 29

North American Risk Services, Inc. Workers’ Compensation CLAIMS FILE NOTE CATEGORIES & CONTENT Reserve Reserves set and why inclusive of specific amounts for various buckets within medical, indemnity, and ex- pense. Return to Work Current disability status on the file. Second Injury Fund Second Injury Fund application to the jurisdiction and injury for this claim. Settlement Settlement plan, negotiations, settlement once achieved. Status Report Brief summary of the claim with objectives, strategic points, and target date to move the file forward. SIU Notes Recommendations for sending a file to SIU. Subrogation Third party involvement, faulty equipment, MVAs, referral to subrogation unit. Treatment Plan Medical information including date of treatment, provider, facility, assessment, and plan. Vocational Rehabilitation Wage information, benefits issued. Wage Benefits Wage information, benefits issued. 30 30