Y(Our) Workers' Compensation Guidebook - The NARS Way

Y(Our) Workers' Compensation Guidebook The NARS Way www.NARISK.com

North American Risk Services, Inc. Workers’ Compensation Table of Contents NARS Way ............................................................................................................................................ 1 WC Credo for Leaders & Specialists ....................................................................................................... 2 WC Best Practices ................................................................................................................................. 4 WC Claims Handling Guidelines ............................................................................................................. 8 WC Claims Handling Timeframes ........................................................................................................... 19 WC Claim Documentation Examples...................................................................................................... 22 Note Categories & Content ................................................................................................................... 33 Return to Work Philosophy ................................................................................................................... 36 QCM Expectations ................................................................................................................................ 38 WC Job Aid & EDI User Guide ................................................................................................................ 44 Litigation Module and Litigation Documentation FAQs .......................................................................... 73

At NARS, we are always... Keeping it fun and Fanatical about response celebrating victories times Operating as a Setting expectations and high-functioning team following through Holding ourselves Taking pride in our work accountable Treating everyone with Dedicated to continuous respect and empathy improvement Proactive in seeking Delivering what is solutions important to our stakeholders

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.

Workers’ Compensation Claims Specialists Credo Workers’ Compensation Claims Specialists are extraordinary leaders of injured workers, formulating optimal plans of recovery to get people back to work, back to life! WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE PASSIONATE We are energetic and curious. We love life and actively craft it to create happiness within ourselves as well as our injured workers. We help injured workers with recovery and goals. WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE CREATIVE 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. WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE INNOVATIVE We embrace technology to advance the workers’ compensation industry. We embrace a new way of thinking about injured workers to create, connect, and push the industry forward. We shape the way workers’ compensation speaks, advocates, empowers to live, work, and thrive. WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE CONFIDENT 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 DETERMINED 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 focus on reality. We change the process to improve understanding and consumption of a complex system. WORKERS’ COMPENSATION CLAIMS SPECIALISTS ARE KIND We are ambitious and driven to make good things happen for others. 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. We are...Workers’ Compensation Claims Specialists And we are here to change the workers’ compensation industry.

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES North American Risk Services, Inc. – Workers’ Compensation 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 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 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 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES  available excess coverage  documentation to support analysis  appropriate worker Class Code for the insured NAICS code  other coverages potentially applying to the loss  injured worker status  evaluation for potential of cumulative trauma or occupational disease • Coverage is determined as soon as the facts and circumstances of the claim and investigation will reasonably allow. • Coverage analysis and application of that coverage to the facts is the beginning of the investigative process of each new claim, and is followed by the basic investigative steps, including timely and clearly communicated decisions to the involved parties on the claim, which are documented in the claim file. • Should coverage analysis yield determination of no coverage, application of no coverage to be documented in the claim file including timely and clearly communicated decisions to the involved parties on the claim. INVESTIGATION: • Investigation is the development of facts and continues throughout the life of the claim. • Investigative tools available to the Workers’ Compensation Specialist include, but are not limited to:  Loss reports, police reports, medical reports, photographs, diagrams, Index results, statements from involved parties and witnesses, experts, receipts, NICB, ODG, claims-related websites, claims handling guidelines, social media, surveillance, etc. • Conduct a pro-active and thorough investigation to resolve the critical/unresolved issues regarding Coverage, Compensability, and Exposure. COMPENSABILITY: • The Workers’ Compensation 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 management. • The investigative material is reviewed and objectively evaluated to determine whether to pay, adjust, compromise, or deny the presented claim in a timely manner. • As decisions are made concerning the claim being investigated, they should be documented in the claim file. • Evaluation of compensability is a continual process that is refined as necessary as the investigation develops and any medical treatment progresses. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES EXPOSURE: • Timely and accurate assessment of exposure begins at the inception of a claim and is achieved by prompt and clear requests for information, continual evaluation of information, and prompt verification of information. • Information is collected to form the basis of the Workers’ Compensation Specialist’s informed decision on the value and exposure of the claim. • 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 Workers’ Compensation Specialist establishes reserves after the issues of coverage and exposure have been identified, investigated, documented, and evaluated. • Reserves are established by the Workers’ Compensation 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 Workers’ Compensation 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’ Compensation 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 Workers’ Compensation Specialist will request defense counsel to provide a litigation budget and legal action plan. • Throughout the life of the litigated file the Workers’ Compensation 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. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

North American Risk Services, Inc. Workers’ Compensation BEST PRACTICES 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. • File documentation is accomplished primarily via Claim Notes and appropriate utilization of Note Types as well as posting pertinent correspondence, reports, and other materials to the claim including but not limited to medical reports, medical bills, and nurse case management documentation. • File reporting is an ongoing process and is consistently and timely updated as new information develops. • Reports are utilized in compliance with company guidelines and include but are not limited to Large Loss, Reinsurance, Pre-Trial and Trial. STATUS REPORT: • A Status Report includes an identification of the critical/unresolved issues regarding Coverage, Compensability, and Exposure, and the investigative tasks to be completed to resolve each critical/unresolved issue that leads the Workers’ Compensation Specialist to develop an evaluation of Coverage, Compensability, and Exposure; and move the claim to disposition, resolution, and/or negotiation. • The Workers’ Compensation Specialist’s Status Report is a clear, concise, and pro-active approach to bringing the claim to a fair and timely resolution. • The Status Report is dynamic, reflecting the strategies for fairly resolving the critical/unresolved issues as additional information is developed and analyzed. EXPENSE MANAGEMENT: • The North American Risk Services, Inc. – Workers’ Compensation Center of Excellence team strives to avoid even the slightest appearance of impropriety when facing actual or potential cases of conflicts of interest by maintaining “arm’s length” relationships with vendors, independent adjusting firms, attorneys, and others with whom it does business. • Workers Compensation 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. • Scopes of assignments to external resources should be specific and limited to assure appropriate expenditures, and sufficient to provide good faith investigation, analysis, and resolution of claims. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims Handling Guidelines The NARS Way – WC Claims Handling Guidelines Performance Standards: • The Workers’ Compensation Specialist should be technically proficient in their responsibilities and work assigned claims accurately and efficiently. All communication, to include emails, text messages, and phone messages, should be responded to in a timely and courteous manner. The specialist will link performance expectations to the goals and be open to feedback, accepting accountability and taking ownership for the work product. File Definition: • Indemnity Claim: Includes all claims with exposure for indemnity payments, including those claims with exposure that have been disputed or denied. • Medical Claim: A claim in which the injured worker did not lose time more than the waiting period but sought medical treatment. Permanent partial disability is not anticipated. • Information Only: Claims where no indemnity or medical payments are made. They are also referred to as “Incident Only”. • Medical Management Only Guidelines: o Claims < $6000 Medical Paid o Less than 3 days lost time. (>3 days, reassign) o MO Specialist handles all injuries except the following: ▪ Psych claims ▪ Amputations ▪ Burns ▪ Head injury ▪ Fatality ▪ Any anticipated permanency ▪ Any surgery o MO Specialist handles strains for the following up to six weeks of treatment: ▪ Back ▪ Shoulder ▪ Knee ▪ Hip ▪ Foot/Ankle • Refer injured workers with treatment > six months • Accepted Claims – No denials to include coverage • Non-litigated files This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines Assignments: • The Unit Manager must reassign a new claim to a specialist within 2 hours of receipt. • The Workers' Compensation Claim Specialist must complete a reassignment review within 7 days for files escalated or de-escalated due to a change in claim type, jurisdiction, or exposure. Files must be in pristine order before reassignment, including but not limited to status reports and reserves, mail, and diaries. • Once the file has been transferred, contact must be made to the employer and the injured worker to notify parties of the file transfer within three days of receipt. Contact must be made via telephone and have written follow-up via letter or email. Coverage: • Upon receipt of a new claim, the Workers' Compensation Claim Specialist should determine if coverage exists within 1 business day and verify the policy period, location, and class code. The Workers' Compensation Claim Specialist should also identify and document exclusions and deductibles. Notification to the client should be submitted if there is questionable activity such as late reporting, incorrect class code, OSHA violations, or the existence of a hazardous condition. • All files must contain a "Coverage" note, either confirming or disputing active coverage. The Workers' Compensation Claim Specialist shall address all the following components in the coverage analysis: o Coverage period – The accident date must fall within the policy period. o 3A and 3C coverage states o Employer/Employee relationship • If the Workers' Compensation Claim Specialist cannot confirm coverage, a notification must be immediately sent to the Unit Manager and client. • The Workers' Compensation Claim Specialist will finalize the coverage investigation no later than 3 business days from the date of receipt. Initial 3-Point Contact: • Contact must be made with the employer within 8 hours or 1 business day, whichever occurs first, of receipt of the claim. A letter, a telephonic, or an electronic message will satisfy the 8-hour contact requirement. • Contact with the injured worker and the primary medical provider must be made within 8 hours or 1 business day, whichever occurs first, of receipt of the claim. Written, a telephonic, electronic message will satisfy the 8- hour contact requirement. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines • Contact with the primary medical provider must be made within 8 hours of receipt of the claim. Written, the telephonic, electronic transmission will satisfy the 8-hour contact requirement. • If initial contacts are unsuccessful on day 1, the Workers' Compensation Claim Specialist must follow up either by phone, email, or text the next business day. If contacts have not been achieved by day 3, the Workers' Compensation Claim Specialist will mail a contact letter to the employer and injured worker. • Incident Only claims may not have a 3-point contact. • The file must contact either a "Contact Achieved" or a "Contact Effort" entry. The claims must indicate "Contact Achieved." If unable to make contact, the tree must reflect "Contact Not Applicable." Initial Investigation - Compensability • The Workers' Compensation Claim Specialist should take a recorded statement on all lost time files and questionable medical only claims, any claims involving potential subrogation, or at the client's request. Witness statements should be obtained as needed. • When applicable, wage statements, a job description, and supplemental reports should be requested from the employer and are required on all indemnity claims. The Workers' Compensation Claim Specialist must calculate the disability benefit based on the AWW, TTD, TPD, PPD, and PTD rates. o Wage statements must be requested within 24 hours of known indemnity exposure. Indemnity exposure includes Temporary Total Disability, Temporary Partial Disability, Permanent Partial Disability, Permanent Total Disability, Death Benefits, and Settlement. o Subsequent requests shall be made every 48 hours until the appropriate wage statement and/or loss earning documentation has been received. If, after 3 requests, the wage documentation has not been received, the Workers' Compensation Claim Specialist must file a risk alert with the client. o The benefit calculation shall be documented in C3 under the "Wage/Income Loss" Category. The Workers' Compensation Claim Specialist must also link the wage statement and or loss earning documentation to the file note entry. • Until the Workers' Compensation Claim Specialist has successfully completed the applicable jurisdictional wage statement training assessment, all AWW must be validated by the Unit Manager. The Unit manager must document their findings in the claim system. Once the Workers' Compensation Claim Specialist has successfully completed the assessment, they are no longer required to seek unit manager validation. However, the unit manager may continue to require validation at their discretion. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines • Compensability must be established within 10 - 14 days of claim receipt by clearly identifying status as accepted, deferred, or denied with supportive justification. Suppose the claim is being placed into a deferred status. The Workers' Compensation Claim Specialist must render an opinion once information has been secured. The Workers' Compensation Claims Workers' Specialist must notify the injured worker and the client of a deferred decision. o All files must contain a "Compensability" note and completion in the Loss Details section of the tree. o The note must clearly and concisely describe the reason for either a denial, deferred or accepted status. o The file must also clearly and concisely describe the loss under the loss description of the Loss Info section of the tree. o The compensability rationale shall include a detailed explanation and must be thoroughly documented and well supported with all the following applicable components: AOE/COE, ER/EE relationship, going and coming rule, injury by accident, pre-existing conditions, injury description inconsistencies, employer level investigation, intoxication, the proximate cause of injury and any applicable case law or statute to support when necessary. o Denials: All claim denials and/or delays must have Unit Manager approval documented in the claim system, and the Workers' Compensation Claim Specialist must obtain client approval when applicable. Unit Managers must keep a reoccurring 45-day diary on all denied files until file resolution and closure. • The Workers' Compensation Claim Specialist should document the file notes discussion of explanation of benefits with the injured worker. The Workers' Compensation Claim Specialist should also send appropriate benefit letters to the injured worker and medical authorizations. Medical Management • The Workers' Compensation Claim Specialist shall take a proactive approach and comply with the applicable jurisdictional rules and regulations. The Workers' Compensation Claim Specialist must direct care in those states where it is permitted. • The Workers' Compensation Claim Specialist must obtain the injured worker's medical documentation and appointment dates and document the file. • The file must reflect a medical treatment plan with a file note "Treatment Plan" to include the diagnosis, prognosis, and any co-morbidities that may impact the treatment plan. • The file note can be completed simultaneously as the Medical Management section of the tree by documenting the treatment plan within that section. • The Medical Management section must also contain the projected Maximum Medical Management target date. The Workers' Compensation Claim Specialist must obtain projected target dates from either ongoing disability guidelines or the physician. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines • The Workers' Compensation Claim Specialist is responsible for using case management tools, when needed, to assist in the medical management of the injured worker. The Workers' Compensation Claim Specialist must request approval from the Unit Manager for all Nurse Case Management assignments and further approval from the client, where necessary. Disability Management - Modified Duty/Return to Work: • During the initial investigation of a lost time claim, the Workers' Compensation Claim Specialist should verify whether the employer is willing to accommodate modified duty. If so, the Workers' Compensation Claim Specialist should advise the treating physician early on and reiterate requests for release to return to work. o The Workers' Compensation Claim Specialist must have a detailed disability plan documented in the file, including projected and full-duty RTW target dates. o The Workers' Compensation Claim Specialist must complete the Work & Benefits Section of the tree with the appropriate disability information. • When the Workers' Compensation Claim Specialist becomes aware that an injured worker has been or is about to be released to modified duty, the employer should be contacted to determine if modified duty is available within the injured worker's capabilities. If the employer cannot provide modified duty, other options should be considered, including but not limited to third-party strategic partners. • If lost time is excessive for the type of injury and the treatment is prolonged unnecessarily, the Workers' Compensation Claim Specialist should consider a second-opinion evaluation. • Indemnity Payments: The Workers' Compensation Claim Specialist must issue all indemnity benefit payments in accordance with the applicable statutory guidelines. The Workers' Compensation Claim Specialist shall utilize all system-generated benefit rule details and must validate such benefits at the time of payment. • Any late payments of initial or ongoing indemnity must be documented in the file and communicated with the injured worker, Unit Manager, and Director. • The Workers' Compensation Claim Specialist may establish recurring payments scheduled for the minimum number of weeks of the expected disability period but may not exceed the following: o Non-surgical disability claims; up to 6 weeks o Surgical disability claims; up to 24 weeks o Permanent disability: may be scheduled for up to 52 weeks or for the entire benefit period, whichever is less o Fatality; may be scheduled for the entire due benefit period This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines o If the recurring payment feature is not utilized, the Workers' Compensation Claim Specialist must maintain the appropriate weekly or bi-weekly benefit payment diary, according to the applicable statutory guidelines. Benefit Reconciliation: The Workers' Compensation Claim Specialist must complete a benefits reconciliation on all indemnity claims within 30 days of the initial indemnity payment and again at the time of return to work. If RTW occurs before the initial 30- day review, then only one reconciliation is necessary. • If a financial inaccuracy is calculated, the Workers' Compensation Claim Specialist must take immediate action. • If an underpayment is discovered, the due payment must be issued to the injured worker within 1 business day of the review. • If an overpayment is discovered, the Workers' Compensation Claim Specialist must attempt to recover the overpayment in full compliance with the applicable jurisdiction's rules and procedures. o The Workers' Compensation Claim Specialist must send an overpayment letter to the injured worker within 3 business days of the review and make subsequent attempts to recoup the overpayment, either by phone or mail, every 30 days after that until recouped or until file closure, whichever occurs first. ▪ If there is no settlement opportunity and a minimum of 3 attempts to recoup have been made without success, the Unit Manager may approve the file closure without recovery. The Unit Manager and/or Workers' Compensation Claim Specialist shall also communicate this decision with the client, and the Director of Claims must be notified. o If the state allows for a reduction of future benefits, the Workers' Compensation Claim Specialist must reduce future benefits, as permitted, until the overpayment is recovered in full. o All overpayments not recovered at the time of any claim settlement must be addressed within the settlement evaluation. Recovery must be pursued in full unless otherwise directed by the Unit Manager or Claims Director. • All reconciliation reviews must be documented, using the template below, in C3 under the "WAGE/INCOME LOSS" category. • All recovery attempts must also be documented in C3 under the "WAGE/INCOME LOSS" category. • Each benefit period and/or benefit type (TTD, TPD, TPD) must be represented separately in the template. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines Caseload/Diary Review: • The Workers' Compensation Claim Specialist's first review should be done within 14 days of receipt of a new loss and the second review within 30 days. A follow-up diary should be based on the severity of a claim, with indemnity claims being reviewed within 45 days and medical-only files at 60 days. Permanent total cases beyond the initial investigation are reviewed every 90 days. • The Workers' Compensation Claim Specialist should maintain a 30-day diary review of their files unless the file is specifically designated to require reviews at a different interval. A diary should be set within 2 days of an injured worker's appointment for aggressive medical and disability management. A Workers' Compensation Claim Specialist should complete all tasks indicated during the diary review to the extent possible. Diaries should not be more than 10 days overdue. A complete diary review should include, but is not limited to the following: o Documentation of all mail received since prior diary review. o Review to address management's comments in the file notes. o Performance of all tasks indicated by the claim status. o Review and process medical bills to ensure timely payment. o Ensure payment due to an injured worker is accurate and timely. o Review reserves for adequacy. o Accurately document actions taken. o Enter a status report for bringing the claim to a conclusion with target dates when possible. o Provide a rationale if there is a change from the previous plan. Reserving: • Reserve Philosophy: Files are to be evaluated on a case-by-case basis. Files will be reserved on all claims for ultimate probable exposure based upon all known information. o All files must have an initial reserve within 7 days of set up. o All files should have a reserve evaluation with the reserve rationale within 30 days of receipt of the claim. o Reserves should be re-evaluated immediately once new information is obtained, which should cause a change in exposure within 15 days. o The Workers' Compensation Claim Specialist may need to increase reserves as the claim develops. "Stair stepping" or frequently increasing the reserves can reflect deficient analysis. While it is essential to avoid over-reserving, the Workers' Compensation Claim Specialist should be able to evaluate the exposure so that frequent changes are not required. The Workers' Compensation Claim Specialist should review the reserves in each diary. o All reserve increases with a new aggregate reserve above the Workers' Compensation Claim Specialist's authority level will require management and/or client approval. o All final close emails with an amount decreasing $50,000 or greater require notice to the Director of Workers' Compensation. o The Workers' Compensation Claim Specialist must document the file, using the "Reserve" entry, with a comprehensive rationale to support the financial transaction. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines o Large Loss Reporting: The Workers' Compensation Claim Specialist shall complete and report all Initial reports due as soon as possible but no later than 30 days of receipt of the claim and then every 90 days after that or pursuant to the client claim handling instructions. o Large Loss Notification or Request: The Workers' Compensation Claim Specialist shall complete and report all large loss notifications and requests to their Unit Manager within 10 days of identifying the need for the report. The Unit Manager shall approve the request or notification within 48 hours of receipt and forward it to the appropriate parties. Communication: • All inquiries must be responded to within 24 hours, whether written or verbal. • The Workers' Compensation Claim Specialist will follow up with the injured worker frequently, in less than 30- day increments, while the claim file is active unless otherwise documented. • The Workers' Compensation Claim Specialist will follow up with the employer in no less than 45-day increments while the claim file is active unless otherwise documented. • All new mail must be labeled, addressed, worked, and moved to the appropriate folder within 3 business days. • Care cards are to be utilized to send to injured workers at the appropriate times, including but not limited to lost time and post-surgery. • A closing note is required, with communication to all parties as appropriate. Settlement Evaluations – Authority – Payments: • The Workers' Compensation Claim Specialist must complete a settlement evaluation within 10 days of receipt of any settlement demand and/or when the claim reaches settlement maturity, whichever comes first. The evaluation must be detailed, accounting for future indemnity, medical, and litigation expenses. • The Workers' Compensation Claim Specialist will request settlement authority from their leader and client if the amount needed is more than the individual's authority limits. The Workers' Compensation Claim Specialist should document the method and/or calculation required to support the settlement evaluation. At that time, the Workers' Compensation Claim Specialist will message the leader and client that authority is needed. The Unit Manager and client's approval should be documented in the file notes, or when required, the Unit Manager should inform the Director. • The Workers' Compensation Claim Specialist will document the file and follow a detailed and appropriate negotiation strategy. • The Workers' Compensation Claim Specialist will issue settlement payments within 2 business days from the receipt of notice of approval. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines Medical Provider and Vendor Payments: • All non-disputed medical provider bills must be paid within 3 business days of bill audit approval and within 30 days of receipt. • All non-disputed vendor bills must be paid within 3 days of receipt of the invoice. Medicare: • The Workers' Compensation Claim Specialist will determine if the injured worker is Medicare eligible. Medicare's interest should always be considered, including but not limited to when settling a claim. All relevant information will be considered to determine if a Medicare Set Aside is needed and/or explore if a Conditional Payment Lien exists. If the injured worker is Medicare eligible, the Workers' Compensation Claim Specialist will provide the defense attorney with the correct release language. • The Workers' Compensation Claim Specialist must complete the required Medicare fields in the claims system on all claims. Subrogation: • Upon receipt of a claim, the Workers' Compensation Claim Specialist should evaluate for any possible third-party negligence such as defective equipment/product or third parties liable for injuries caused to the employees and document analysis in the claim file. When the Workers' Compensation Claim Specialist identifies potential subrogation, the Workers' Compensation Claim Specialist should send a referral to the subrogation unit (or preferred subrogation vendor per client) to review the file. • Upon review of the claim, the leader should determine if potential subrogation has been identified and referred accordingly per client direction. Second Injury Fund: • Identify if the state where benefits are being paid has a second injury fund available. File Documentation and Organization: • The Workers' Compensation Claim Specialist must maintain the integrity of every claim file, and the notes must be proactive, professional, and positive. Falsifying events or destroying or altering documents to falsify the record will not be tolerated. The file notes should reflect an accurate accounting of the accident/injury and provide the needed information to support the methods used in handling the claim. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines • The Workers' Compensation Claim Specialist should use the appropriate filter to identify the note when entering it into the claim file. For example, entries made regarding litigation should be identified as legal. Further direction is provided in the Claim File Expectations document. • The Workers' Compensation Claim Specialist shall document all claims' handling activities on the same day that such activity occurred. File documentation must be an accurate reflection of the activity and must be detailed. The Workers' Compensation Claim Specialist shall use the appropriate note category, as outlined in the Workers' Compensation Note Categories document. • Every file note with a linked document must also contain a summary of the enclosed document. Litigation Management/Attorney Involvement: • Please see the Workers' Compensation Litigation Management Process document. Reporting Requirements: • A Large Loss Report is to be completed per client-specific guidelines with review by leadership. • Index reports are required on all claims and should be documented in the claim file. • The Workers' Compensation Claim Specialist must file all State forms within statutory requirements and guidelines. Completion must be documented in the claim file. • Reinsurance reports are to be completed per client direction. Status Report: • The Workers' Compensation Claim Specialist's vision for the future of the claim is demonstrated in the Status report, focusing on getting the injured worker back to work, back to life, and file closure. • The Status Report is a clear, concise, and proactive approach to bringing the claim to a fair and timely resolution. • The Status report is dynamic, reflecting the strategies for fairly resolving the claim as additional information develops and is analyzed. • The Status Report will be documented as "Status Report" in the file. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Guidelines Unit Manager – Quality Case Management Review (QCM) • The Workers' Compensation Unit Manager's review of the claim file should include but not be limited to the following: o The Unit Manager's initial review must include a thorough review of all claims handling guidelines and completion of C3 mandatory requirements. The first review should be done within 15 days of receipt of the claim. o The ongoing QCM should follow the severity of a claim, medical only, indemnity, or permanent total. Then note must include a summary of the status, a review of the reserves, and recommendations for file direction. o The Workers' Compensation Claim Specialist should submit all Large Loss Reports, Reinsurance Reports, and notifications to clients to leadership for review. o Reserves, settlement authority, and payments above the Workers' Compensation Claim Specialist's authority should be submitted to the leader for approval before implementation. Expense Management: • The Workers' Compensation Claim Specialist is responsible for exercising reasonable business judgment in selecting, retaining, and managing external resources to facilitate fair and prompt claims resolution. • Utilization of case management must be clearly outlined in the claim file identifying the need, purpose for assignment, and the outcome anticipated by involvement. • Assignments of outside strategic partners are up to the Workers' Compensation Claim Specialist's discretion and per client guidelines. This document contains North American Risk Services – Workers’ Compensation proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services.

Workers’ Compensation Claims Handling Timelines The NARS Way – WC Claims Handling Timelines Action Item Due Date Comments The Unit Manager has 2 hours to reassign a new claim to a specialist. The UM is notified by Assignments UM will assign within 2 hours email, metric, and diary. The specialist shall close any claim that has reached closure maturity within 24 hours. The specialist shall zero all claim reserves out and shall document the reason for the file closure. Closures Within 24 hours The compensability rationale shall include a detailed explanation and must be thoroughly documented and well supported with all the following applicable components: AOE/COE, ER/EE relationship, going and coming rule, injury by accident, pre-existing condition, injury descriptions inconsistencies, employer level investigation, intoxication, proximate cause of injury any applicable case law or statute to support when necessary. The Loss Details tab of the tree must also be Document a file note and marked compensable, denied, or deferred Compensability complete C3 within 10 days decision. Initiate a coverage investigation within 1 business day from receipt All files should contain a “Coverage” note, Coverage of claim. Max 3 days. either confirming or disputing active coverage. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims Handling Timelines The NARS Way – WC Claims Handling Timelines The claims specialist may establish recurring payment scheduled for the minimum number of weeks of the expected disability period but may not exceed the following: • Non-surgical disability claims: up to 6 weeks. • Surgical disability claims: up to 24 weeks. • Permanent disability: may be scheduled up to 52 weeks or for the entire benefit period, whichever is less • Fatality; may be scheduled for entire due benefit period. The payment must be documented in the file notes. Any missed indemnity payments require a phone call to the injured worker and must be reported to the UM. All late payments are Should be paid on or before the escalated to the Director. Indemnity Payments due date as allowed by statute. Must be completed within 30 days of the initial indemnity payment If RTW occurs before the initial 30-day review, Indemnity Benefit and again at the time of return to then only one reconciliation is necessary. Reconciliation Review work (RTW). Incident only claims may not have a 3-pt contact. A fax or letter to the provider counts as 8 business hours or I business day, provider contact. Initial 3-point contacts whichever occurs first Reserves must be reviewed and adjusted within 15 days of any material change. The file must be adequately documented Initial and Subsequent Reserve Within 7 business days of claim using the reserve template and justification. transactions receipt LLR or LLN Within 10 days of a significant UM’s and the Director have 48 hours to change or need for modification. review and forward to the client. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims Handling Timelines The NARS Way – WC Claims Handling Timelines Must be paid within 3 days of approval and within 30 days of Medical Payments receipt. ARC Payments Within 3 business days of All mail should be labeled, filed, and worked New Mail receipt accordingly. Phone and Email Within 24 hours or 1 business Prompt responses within 24 business hours of Communication day. receipt for all communications. Initial QCM is due by day 15, The QCM should cover a thorough review of all second review is day 30, QCMs claims handling guidelines and completion of C3 Quality Case Management thereafter follow the status mandatory requirements and give strategic Review or QCM report timeline. direction where needed. Reassigned File Review within 7 days Bulk reassignments are excluded. Must be completed within 10 business days of receipt of any settlement demand and or when the claim has reached settlement maturity, Settlement Evaluations Within 10 business days whichever comes first. Within 2 business days of The payment must be documented in the file Settlement Payments receipt notes Within 3 business days of any client request and or red flag identification SIU Referral Within 3 business days Subrogation Referral Within 14 days This will be captured in the compensability entry Within 10 days of claim receipt. Confirmation status report on day 30 from receipt of the The plan should be proactive and should have claim. Medical Only follow-up ultimate file resolution as the vision. Address any status report every 60 days and red flags and plans to mitigate the claim thereafter, Lost Time claims exposure. every 45 days thereafter and Status Report long-term Medical Check every two hours for reserves and payment release. Reserve Approvals >50K require a note in the file by the UM. Approvals >500K require a Unit Manager and Director– Released and approved several note in the file from the Director. Payments and Reserves times daily. Call 2 injured workers per specialist per month. Track all calls by Claim Number, Name, Client, Complete 2 per specialist per Date and Response. UM Success Calls month. Must be paid within 3 days of approval and within 30 days of C3 Payments Vendor Payments receipt 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide Authority/Authority Requested – Note Category “Authority” BEST PRACTICES Injured worker was involved in a fatal accident. According to account handling instructions, this is considered a large loss and has been reported to Joe at customer on this date. Closure Note – Note Category “Closure” Contacted the injured worker and advised we paid all bills associated with the claim so that we would be closing the claim. Advised the injured worker to call if further questions arise. Communication – Ongoing – Note Category (Employer or Injured Worker) “Contact” A telephone call (text, email) to the 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. I 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. (INJURED WORKER) Compensability – Note Category “Compensability” This file is eligible for benefits under Nebraska jurisdiction as the injured worker is a janitor who was mopping the floors of the school when she turned and heard a pop in her back sustaining a low back injury to the L5-S1 level. As the 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. This file is not eligible for benefits under Iowa jurisdiction based upon idiopathic condition as the injured worker fainted while walking down the hallway at work. As the syncopal episode is related to the injured workers’ personal health condition and not her employment, file is denied under Iowa Workers’ Compensation. Coverage – Note Category “Coverage” 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 there is no coverage, please state clearly why and the next steps for the claim 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES EDI/State Filings – Note Category “EDI/State Filings” Filed FROI with State of Iowa 11/08/2020. IP filed with State of Iowa on 11/10/2020. S1 filed with State of Iowa on 11/14/2020. FN filed with State of Iowa on 11/30/2020. *Attach document. Initial Injured Worker Contact – Medical Management Only Claims – Note Category “Injured Worker – Contact” Medical only with treat/release treatment: Called the injured worker and introduced myself as the contact for any future needs related to this workers' compensation claim. Provided my contact information. I also sent a letter with the employee brochure. Initial Employer Contact –Note Category “Employer – Contact” Use Employer Interview Template and document a summary to the file: Example: Contacted Wayne Skull, WC Contact for KBL Design Center. He confirmed the IW's supervisor. He does not directly supervise the IW but confirmed the hire date as 1/1/2005. He also confirmed he is a light installer/technician and does not question the injury. He confirmed his wages of $25/hour, 8 hours per day, and no more than 40 hours per week. He did pay him for his two days of lost time and confirmed the lost time days of 7/23 & 7/24. RTW full duty on 7/25. He does have the box cutter and confirms there is nothing defective with the box cutter. He prefers we communicate with the IW's supervisor, Matt Gibson, throughout the life of the claim. Contacted Matt Gibson, IW's supervisor. He confirmed the incident description, picked the injured worker up, and drove him to the emergency room. He also took the box cutter and confirmed no defects. The injured worker did not use the device properly and was not paying attention. He confirmed the location of the incident and did not have any reason to question the incident. He prefers we do not contact the customer regarding the details. He is aware of the next office visit on 8/1, and they will pay the IW to attend the appointment. He prefers to communicate by text also, and his number is 123-456-7899. I asked if he had completed an internal supervisor form for the accident, and he did. He will forward it to our file. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES *If you need to send an email to the employer. The list of questions is in the templates. Please attempt to contact by phone initially and send an email only if you cannot communicate by phone or if the employer prefers email. Always request the following documentation: Internal First report of injury, safety investigation, medical note(s), work slips, etc. Initial Injured Worker Contact – Note Category “Injured Worker – Contact” (Use Recorded Statement Template to gather information but document in summary) Injured Worker: I called and spoke with the IW, Raymond Stevens. He prefers to be contacted by text message, so I confirmed his phone number. He is 6’ 2” tall and weighs 220 pounds. He is right-hand dominant, with brown hair with blue eyes. He does not wear glasses. I confirmed his date of birth as 1/7/62 and his address as 309 S. Prairie St, Below, AZ. He is married and has two sons over the age of 18. He speaks English. He has a high school education with trade school experience but is not a licensed electrician. He has worked for KBL Design Center as a light fixture installer and service technician for 17 years. His supervisor is Matt Gibson. He works 8 hours per day, 40 hours per week. He works the daytime shift. He makes $25 per hour. He does not have any concurrent employment, and before working for KBL, he worked for the City of Below as a laborer. He does not have any medical conditions and no history of any prior surgeries. He does have group health insurance through KBL Design and has never applied for Medicare or Medicaid. His hobbies outside of work include deer hunting with a shotgun and no bow. Accident Raymond reports he was injured on 7/22/22 when he cut his hand while removing a light fixture from the packaging. He was on-site at a customer location when the incident occurred. The only witness was the customer, Louisa Bell. He cut his right hand. No other injuries. He called his supervisor right away while bandaging the hand. His supervisor picked him up at the customer location of 609 S. Timber St., Below, AZ, and drove him to Mercy Hospital in Phoenix, AZ. He was admitted into the emergency room and treated with 23 sutures. He explained he cut his hand with a box cutter. He did not feel there was anything wrong with the box cutter. He confirmed the diagnosis as a laceration to the palm of the right hand. He was referred to a hand specialist for follow-up – Dr. Clyde Grady with the Mercy Medical Professional Building in Phoenix, AZ. His next appt is scheduled for 8/1/22. He lost two days of work on 7/23 & 7/24, returning to work on 7/25. He has an off-work slip from the emergency room. He was drug tested at the ER also. I explained his benefits for the state of AZ and sent him an employee brochure by email. He will forward his off-work slip to me by email, and we will continue to communicate by text message. Explained WC benefits and Rx/medical bill review process. Also provided state references as a resource. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES Investigation – Note Category “Investigation” ISO report returned five hits. The injured worker was previously involved in four other workers’ compensation claims which were handled by Travelers. Request is being made to obtain information for these ISO hits. The fifth hit is for an MVA through State Farm. Information requested. ISO returned two hits. One is not for the injured worker but someone with a similar name. The other is for the injured worker’s daughter. ISO report okay and no further information is needed at this time. Belleview Police Report received. Our injured worker was at fault. Third party information obtained: Joe Smith, 43, Allstate policy, etc. Forwarded to NARS Subrogation Unit. Social Media scrub resulted in a hit indicating the injured worker was skiing based upon his Facebook profile the weekend before reporting his workers’ compensation injury to his employer. Litigation – Note Category “Litigation” Referred file to defense counsel to include a file summary as attached. Litigation module completed. Upon response from Counsel: Received legal plan of action and budget from Defense Counsel. Budget is for $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 injury's nature and the injured worker's location. Suggestions for further workup include obtaining an IME and scheduling the injured worker's deposition. Legal review with Pernie Law Firm. 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. Managerial Notes – Note Category “Managerial Notes” Separate guide for Workers' Compensation Unit Managers - Quality Claim Management Review. Summary: This is a low-risk claim for a finger laceration. Compensability has been accepted and appears it is a one-time treat with release. Lost time within the waiting period. Reserves: Reserves are adequate for the exposure. Recommendations: Please follow up for the release documentation and put on diary to close once bills are paid. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES Medical Management – Note Category “Treatment Note” (Document in Medical Management Section and will carry into file) DOS: 1/12/2021 Dr. Jon Smith, Specialty Listed Mercy Medical Center ASSESSSMENT: Low back strain. PLAN: Recommending physical therapy 3 x week for 4 weeks, NSAIDS, MRI of lumbar spine, FU in 6 weeks (include date). ATTACH MEDICAL RECORD TO NOTE. * Medicare – Note Category “Medicare” Injured worker is a Medicare recipient with HCN: 45324A432. File has now settled. TPOC entered on 11/08/2020. Conditional Payment Notification received. Information sent to Cattie & Gonzalez to assist in lien. Received Conditional Payment Ledger in the amount of $24,000.00. Notification sent to my Unit Manager by diary. Negotiation Plan and Negotiations (the back and forth) – Note Category “Settlement” In the medical notes, disability, and caselaw review, this knee injury with a medial meniscus tear will settle between 15-20% of the knee. I will negotiate with the injured worker directly, so there is no need to involve defense counsel. (Use the Negotiation tab in Reserves to outline your back and forth. It will flood into the Litigation module if you have it completed.) No demand from the injured worker, so I will begin with an offer of $12,500 or 15% of the leg. In review of the medical notes, disability and caselaw, I assess this knee injury with an ACL reconstruction up to 40% of the knee for IL. The injured worker is represented, so I discussed with defense counsel, and we came up with the following negotiation plan: Opening demand from the petitioner's attorney: $50,000.00 or 40% of the leg. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES I responded to the attorney with 30% of the leg or $30,000, given the short amount of lost time. Cases in IL with little lost time, quick recovery, and no complications resolve in 30-35% range. Response from injured worker's Counsel: $40,000.00 or 35% of the leg. Response: Resolved the claim for 32.5% of a leg or $37,000. *If the specialist does not negotiate the claim, please document why the defense counsel negotiated resolution. Nurse Case Management – Note Category “Treatment Plan” Requesting Field Case Management assistance on this file as the injured worker sustained severe injuries to his right arm. Tasking FCM to assist with medical treatment facilitation as the injured worker does not speak English and due to the nature of his injuries, requesting we have someone accompany him to medical appointments for proactive care and complete understanding of medical treatment. Have also asked FCM to prep injured worker for appointments to alleviate fear of the unknown as well as follow up post appointments for a recap of what transpired at the medical appointments. Looking to task assign case management for further understanding to be communicated between the medical provider and the injured worker for a total of six visits to verify medical treatment plan is in place. Reserve – Note Category “Reserve” 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 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 of the injured workers’ neck issues. Subrogation has been ruled out because of both pieces of equipment were owned and operated by the employer/employees. Utilize C3 Template. Second Injury Fund – Note Category “Second Injury Fund” This is the second injury to the injured workers’ right arm and based upon Iowa jurisdiction, the Second Injury Fund applies. Notification sent. The Second Injury Fund is not applicable in X jurisdiction. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES Status Report – Note Category “Status Report” This is an Iowa claim in which a 23-year-old cook slipped and fell in the kitchen while washing dishes at The Bistro. He sustained a fracture to his right arm and underwent surgical intervention with Dr. Smith at GIKK Ortho on 6/7/2020. His last follow-up was on 8/6/2020, when the injured worker was released to a modified duty of no lifting greater than 25 pounds. He returned to work with restrictions on 8/7/2020. Critical Risk Assessment: Claim is a low risk given the compensable right arm injury, no red flags, and witnessed injury. No surveillance is needed at this time, and agrees with the medical treatment, so there is no reason to question it. Goal: Return the injured worker to his pre-injury employment and issue any impairment owed as a result of injury. Strategic Points: 1. Follow up with injured worker on a weekly cadence until released from medical care to ensure progress and healing are moving forward. This will be done by telephone and followed up by email. 2. Obtain a full duty release at the next appointment: 12/4/2020. Will follow up with injured worker for Patient Status Report post appointment and provide a copy to the employer. 3. Target date for MMI is Jan. 2021. If we do not obtain a release, we plan on an IME, recommend sending a nurse to the next office visit, etc. 4. If we obtain MMI, pursue a permanency rating and issue payment. Process all medical bills and finalize EDI with the State. Target Closure Date: 02/28/2021. SIU Notes – Note Category “SIU Referral” No referral to SIU at this time. See investigation file note. Subrogation – Note Category “Subrogation” There is no third-party involvement or faulty equipment in this matter. There is potential subrogation against the driver as this was an MVA in which the injured worker was struck from behind while traveling for work. File has been referred to the subrogation unit/SubroIQ for assistance. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES Vocational Rehabilitation – Note Category “Vocational Rehabilitation” Mr. Smith has been assigned as the qualified rehabilitation professional to this claim. We are looking to return injured worker to the workforce and will be following up with Mr. Smith for progress in this arena. At the present time, we know injured worker has a GED with a mechanical background and Mr. Smith will be looking for areas of opportunity for placement. Wage Benefits – Note Category “Wage Benefits” AWW: $1,000.00 S-1 W/C Rate: $674.00 Jurisdiction: Iowa AWW calculated taking the 13 weeks prior to the DOI (04/14/2020), totaling $7,475. $7,474.00 / 13 = $575.00 AWW: $575 X 2/3 W/C Rate: $383.33 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 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 being issued from 05/08/2020 to 08/03/2020 for 12.5 weeks of benefits at $674.00. *Attach documentation! **If estimating the wage rate, document and justify the estimated rate with the calculation in the note. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Claims File Documentation Examples The NARS Way – WC Claims File Documentation Example Guide BEST PRACTICES Wage Benefits – Note Category “Wage Benefits” Benefit Reconciliation Review Template 1. Is there a valid wage statement on file (yes or no)? a. If no, has it been requested, and how many times? 2. Date of disability: 3. AWW/CR: 4. Has the IW RTW (yes or no)? a. If yes, what is the RTW date? 5. Has MMI been achieved? a. If yes, what is the impairment percentage? 6. _____ benefits due from _______ to _________ equating to $ _________ 7. We paid ____ benefits from _______ to __________ equating to $ ___________ 8. Is there a financial inaccuracy (yes or no)? a. If yes, what is the inaccuracy? 9. If there is an underpayment, have all due benefits now been issued (yes or no)? If there is an overpayment, what is the plan to recoup? CONFIDENTIALTIY NOTICE This document contains North American Risk Services, Inc. proprietary information that is privileged and confidential. It is to be used exclusively by the individual to whom it was given and is not to be copied in full or in partial or the information herein communicated in any manner to anyone who is not employed by North American Risk Services. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Note Categories & Content The NARS Way Claims File Note Categories & Content Authority Requested Authority requested of client and/or NARS leadership. Closure Confirmation of all benefits paid, and parties contacted. Reason for closure. Compensability Acceptance, denial, or deferral of the claim, jurisdiction, and justification. Contact Communication with Injured Worker and Employer, determined by a filter. Injury cards, birthday cards, Anniversary cards documented if sent. Statements from the injured worker. Coverage Analysis of the coverage applicable to the workers’ compensation line. Diary Specialist or UM response to a Managerial Note – Response to a diary. Subtitle “Response to Managerial Note” EDI/State Filings State form filings include what document was filed, its date, its status, and the subsequent filing. Investigation Police reports and ISO reports that were reviewed. Currently, an “ISO Report Completed” comes back into the file, an automated system note. This is what the adjusters do with it. Large Loss Report Client notification for reserves, payments, and settlements. Litigation All legal correspondence, including a budget, plan of action, and an assessment. Managerial Notes Workers’ Compensation Unit Manager Notes. Claim assignment information upon leadership review. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Note Categories & Content The NARS Way Claims File Note Categories & Content Medical Medical information outside the treatment plan includes medical documentation, preauthorization, and appointment status. Subtitle examples: Medical Documentation, Pre-Authorization Medicare Medicare information, filings, and correspondence. Nurse Case Management Requests for Nurse Case Management. Nurse Case management updates and information. Pharmacy Pharmacy Benefit Manager approval/rejection with commentary as needed. Reserve Reserves set and why inclusive of specific amounts for various buckets within medical, indemnity, and expense. Roundtable Evaluations with defense counsel or a nurse case manager where they are not assigned to the file. Second Injury Fund Second Injury Fund application to the jurisdiction and injury for this claim. Settlement Settlement plan, negotiations, and settlement once achieved. Status Report Summary of the claim with objectives, strategic points, and a 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 includes the treatment date, provider, facility, assessment, and plan. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Note Categories & Content The NARS Way Claims File Note Categories & Content Vocational Rehabilitation Wage information and benefits issued. Wage Benefits Wage information and benefits issued. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Return to Work Philosophy The NARS Way – Return to Work Philosophy Return to work programs is an absolute necessity when attempting to return an injured worker to work in some capacity as quickly as possible following an industrial injury. These programs can significantly reduce the number of lost time injuries and workdays by making reasonable and meaningful accommodations that meet the employees' physical limitations during recovery. Other potential benefits are reduced indemnity costs, improved employee morale, increased productivity, and reduced attorney involvement. Many injured workers can perform modified duties as soon as the day after the accident. Thus, the claims specialist shall establish a return-to-work plan on all claims involving lost time and begin the plan during initial conversations with the injured worker and the employer. • This plan aims to return the injured worker to an appropriate level of employment at the appropriate time based on medical and functional capabilities. • The claim specialist shall aggressively engage in return-to-work solutions during initial claim contacts and shall continue efforts throughout the life of a lost time cycle. • The claim specialist shall proactively work with the employer, injured worker, nurse case manager (when assigned), and medical provider to develop an early return to work plan. • The claim specialist shall use an appropriate return-to-work tool when developing a return-to-work plan. • Within 2 business days of each medical appointment, the claim specialist must contact the injured worker and the employer to continue solution discussions and update the plan when applicable. • When lost time exceeds or is expected to exceed 2 weeks, the claim specialist shall obtain a full duty and/or modified/transitional job description from the employer. • If the injured worker has returned to transitional duty, the claim specialist shall continue efforts to secure a full duty release unless the treating physician has assigned permanent restrictions that may preclude actual full duty return to work. The return-to-work plan, at a minimum, should capture the following: • Work status and expected duration • Maximum medical improvement predictions • The employer's return to work options • The employee's transferable skills and education level • Is the current/expected disability period consistent with the disability duration guidelines? If no, please explain. • Are there any idiopathic or pre-existing conditions impacting return to work? If yes, please explain. • Rationale and documentation of return-to-work tools utilized (i.e., transitional offerings, strategy conferences, job description, independent medical evaluations, functional capacity evaluation, ergonomic assessments, labor market survey). • Validation review of reported physical disabilities (i.e., comparison of physical exam findings with therapy notes, review of the functional capacity evaluation) • Strategy and disability management next steps • Ongoing communication with the employee after modified or full RTW. 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Return to Work Philosophy The NARS Way – Return to Work Philosophy The claim specialist's return to work strategy, at a minimum, should capture the following: • Reduced hours/graduated return to work plans • Alternative schedule options • Alternative position options • Training • Assignment of a field case manager • Assignment to a transitional return to work partner • Conference A strategy conference shall occur in the following situations: • The injured worker remains out of work beyond the expected disability period • The employer indicates that they do not have transitional/modified work available • The injured worker is no longer employed with the employer • The injured worker is refusing a job offer The conference may include any, but is not limited to, the following: • Unit Manager • Claims Director • Employer (and or the client's loss control/risk management team) • Nurse Case or Vocational Case Manager • Defense Counsel If the disability continues beyond the expected disability period, the claim specialist shall consider any of the following: • Independent Medical Exam • Functional Capacity Evaluation • When allowed, request a referral to a new treating physician • Consider vocational assessments • Peer-to-peer review 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations Contacts Prompt contact is an essential part of good customer service and proper claims handling. From the limited information provided on the First Report of Injury, Workers’ Compensation Claim specialists can expand their understanding of the events surrounding the accident during this initial voice to voice contacts. With timely voice to voice contact within a short period of time after the receipt of the claim, the claim specialist can obtain a sense of the employee’s injuries arising out of and in the course of their employment. During this initial contact, the claim specialist needs to fully explain the applicable Workers’ Compensation benefits to the injured employee and the claim specialist role throughout the process. This should place the employee at ease, knowing (and understanding) what benefits are provided to address the financial exposure of the incurred medical expenses and loss of potential wages. Explanation of other benefits, such as mileage, should also be explained. Questions to ask yourself while reviewing for contacts: • Was contact made with the employer within 8 hours on the date the claim was reported? • Was contact made with the injured worker on the date the claim was assigned or within 8 hours of receipt? • Were initial contact efforts timely? (One time per day: hourly is excessive…four days is too much) • Were benefits and the claims process properly explained to the injured worker? • Were follow-up contacts appropriate? Suggested recommendations for improvement with contacts: • Attempt to make voice to voice contact with the employer and the injured worker on the same day the claim is reported. If the initial attempt is unsuccessful, try again the next day and include a text and/or email. • Establish an activity for timely follow up of the initial attempt and subsequent contacts. • Document all contact attempts in the claim file either the day it is accomplished or the next day. Do not allow days or weeks to pass prior to documenting contacts. • Regarding reassigned claims, have the claim specialist contact the injured worker and the employer within three days. Communication • Did the specialist communicate with the injured worker monthly while off work? • Did the specialist communicate with the injured worker to discuss significant changes, throughout the life of the claim? • Did the specialist communicate with the employer to discuss significant changes, throughout the life of the claim? • Did the specialist send a card or flowers during the life of the claim, when applicable? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations Coverage Upon assignment of a new claim, the claim specialist should perform a thorough review of the coverage and document the pertinent provisions in the file. When confirming coverage, the claim specialist needs to verify the effective dates of the policy, locations and states covered; deductibles (as appropriate) and employee listed on the policy. Questions to ask yourself when reviewing for coverage: • Was the date of loss confirmed? • Was the jurisdiction confirmed? • Was coverage properly reviewed/documented? • Were there coverage issues that needed investigation? • Were coverage issues properly investigated? • Were coverage issues resolved appropriately? • Was coverage applied with an analysis? Suggested recommendations for improvement with coverage: • Is the date of injury within the policy period? • Have we verified the injured worker is indeed an employee of the employer? • Has the claim specialist provided an analysis applying the information secured from the investigation to the policy? Review (Investigation) Upon receipt of a new claim, a thorough investigation should be immediately initiated. The claim specialist needs to first center on the question “Did the alleged accident arise out of and in the course of employment?” Gathering the facts from both the employer and the injured worker is important, not only in knowing how the accident occurred but to develop an understanding as to the injury and what type of medical treatment is being received presently and potentially will be in the future. If the investigation reveals the accident was caused by the negligence of others, it is essential the claim specialist be proactive to preserve the evidence to seek recovery against the third party. There is always the necessity to consider each loss individually and to exercise sound judgement as to what investigation is needed for a particular claim. Additional effort may be needed on more complex and serious losses. In those claims where the injured worker is reported to have suffered lost time because of the accident, the claim specialist needs to secure a recorded statement in a timely manner. (Recorded statements need to be obtained on all lost time, questionable, and subrogation claims in addition to client specific instructions.) Questions to ask yourself while reviewing for investigation: • Were the facts of the accident/injury gathered and documented? • Were recorded statements taken and documented? • Was an assessment of compensability accurate and clearly documented? (Clearly documenting how the injury related to the injured worker’s’ occupation, state jurisdiction, and applicability to the work.) • Was the first full day off and first date of disability documented? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations • Was the “Average Weekly Wage” calculated accurately and documented, including proper jurisdiction? • Was subrogation recognized, documented, and referred if appropriate? • Are there any SIU issues? • Were ISO matches addressed? • Was the 14-Day status report completed on time? • Was the compensability decision made within 30 days? • Suggested recommendations for improvement with investigation: • The claim specialist should use the information provided on the FROI as a starting point for the investigation and it should not be relied on as the full scope of information. • Once the claim specialist has gained knowledge the injured worker is losing time from work, the claim is questionable, or there is subrogation potential, immediately take the necessary steps to obtain a recorded statement (or as outlined in the Special Handling Instructions). • If an injured worker suffered an injury in the course of employment which may have been caused by a third party, the claim specialist needs to refer to the subrogation unit for the assessment of subrogation potential and feasibility of recovery. • If any injured worker is off work or anticipated to be off work longer than two weeks, what is the return-to- work plan? Has one been outlined? Has a plan been discussed with the employer? Has a job description been obtained? Was it sent to the treating medical provider for review? Is there medical documentation to support the lost time? Evaluation Once the investigation has confirmed the accident did arise out of and during the injured worker’s employment, the claim specialist needs to turn their attention toward evaluating the injury. The cornerstone to the evaluation process is obtaining the medical records and determining if the treatment received was a result of and directly connected to the accident. Each file should be documented with the claim specialist thought process outlining support for the payment of medical expenses, lost time, compromise settlement, or a denial. A medical treatment synopsis should be documented in the file every 30 days. Medical expenses need to be reviewed and confirmed that the treatment received was necessary and as a direct consequence of the accident. Management of external medical strategic partners should also be documented in the claim file. Questions to ask yourself while reviewing for evaluation: • Is there clear documentation of compensability? • Are the compensable accident/injuries clearly identified and documented? • Was all medical treatment casually related to the reported injury? • Was the diagnosis, prognosis and treatment plan documented? • Were ongoing disability guidelines documented? • Did the claim specialist document their analysis to support payment, compromise, or denial? • Were all medical bills verified as being related to the injury? • Was there any duplication of payment on bills? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations • Were all strategic partners effectively managed? (Documenting the purpose, the intent, and the anticipated outcome and the duration for use.) • Were medical bills promptly paid per jurisdictional guidelines? Suggested recommendations for improvement with evaluation: • The claim specialist should verify the medical care that has been received and any future planned treatment is causally related to the alleged injury. The claim specialist should verify the medical expenses incurred and submitted for payment are only for the treatment received because of the work-related accident. • In addition to obtaining the medical case records, the claim specialist needs to outline their thought process as to causation between the alleged injury and the medical treatment. • The claim specialist should be aware of the jurisdictional time limitation of payment of medical expenses. • For both management of medical and disability, target dates are needed on the file. Reserving Claim reserving is a significant function of The NARS Workers’ Compensation Team. Having a consistent reserving philosophy is imperative to the organization. Reserves are to be set to the ultimate probable outcome with all known information. Ultimate probable outcome is defined as the total incurred cost of the claim which includes the paid and the reserve remaining. We should reserve for the “middle of the road” probable outcome of the claim, not the worst-case scenario nor over-optimistic. Justification and clearly documented, concrete information to provide sound reasoning for recommended reserves is to be noted in the claim file. Reserve notes should have a short summary with an outline of the outstanding reserves and reasoning for needing different buckets for money (such as medical, indemnity, and expense) left on the claim, even if no changes are being made. We need to be able to understand risk and exposure. If we do not understand how much the claim is going to cost, we do not understand the claim. Questions to ask yourself while reviewing reserves: • Are the reserves adequate for the present exposure of the file? • Do the reserves encompass all the known aspects of the claim file? Negotiations Documenting the reasoning behind any payment of medical expense or loss wages is crucial to the Workers’ Compensation process. Questions to ask yourself while reviewing for negotiations: • Were negotiations properly implemented? Was a strategy executed properly? Evidence to support? • Were negotiations properly documented? • Were negotiations updated during the process? • Were all forms completed, in the file, and used to support position taken during negotiation? • Was there attorney involvement? Was attorney involvement needed? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations Payments Leakage applies when lack of documentation to support payment of medical expenses or payment of loss wages. Medical bills need to be in the files to support payment of the medical expense. Duplicate payments can occur. There are also times where a claims specialist may not timely provide the injured worker with the required 30-day notice of termination of loss time benefits. There are also times where questions may arise if an alleged injury results from the work-related accident or if it is the result of other circumstances such as the result of an employee’s long-time hobby. Review of loss wages for accuracy and jurisdiction are a must at the present time. Questions to ask yourself while reviewing payments: • Have lost time benefits been issued accordingly? Were the benefits issued timely? • Do we owe the waiting period? • Was the appropriate jurisdiction used for wage calculations? • Were the appropriate state forms filed related to payment of benefits? Management Involvement • Management involvement in claims is dictated by the complexity of the claim and experience level or performance of The NARS Workers’ Compensation Team claim staff. • Questions to ask yourself while reviewing for management involvement: • Has direction been given in the claims file per best practices? • Has direction been followed? • If the claim direction has not been followed, is further follow up warranted? File Administration • Were all C3 Tabs completed per best practices? • Was the work comp type accurate? (Incident, MO, Indemnity) • Was the class code completed and is it accurate? • Were the injury codes confirmed and are they accurate? • Was Linked Claim marked when applicable? • Was the first Payment completed on time? • Were ongoing payments completed on time? • Were account handling instructions followed? • Were cards or flowers sent to the injured worker, when applicable? • Was the diary system used and followed? • Are metrics up to date? • Was Big 5 Data completed for Medicare? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Workers’ Compensation Quality Claim Review Expectations The NARS Way – Team Leader - Quality Claim Review Expectations Overall • We are the experts. Our files should reflect such. If it is not in the file, it did not happen. • Does the overall claim file clearly document all activities? • Does it read like a book? • Are the notes professional, proactive, and positive? • Is this work product reflective of the NARS Way? • Is it something we can be proud of pushing back to work, back to life, file closed? 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 authorization. Unauthorized use or distribution may be subject to civil and/or criminal penalties.

Pa Workers’ Compensation Data Fields and EDI Reporting

Workers’ Compensation Data Fields 2 Table of Contents Overview ............................................................................................................................................ 3 Data Accessed through the “Details” tab of the Summary page ........................................................ 3 Policy Type ...................................................................................................................................... 3 Jurisdiction Claim # ......................................................................................................................... 4 Denial .............................................................................................................................................. 4 Subrogation .................................................................................................................................... 5 Disputed Case/Controverted ........................................................................................................... 5 Data Accessed through the Claim Tree ............................................................................................... 7 Loss Information ............................................................................................................................. 7 Injured Worker ................................................................................................................................ 8 Primary Employer Data Fields........................................................................................................ 11 Medical Management Field ........................................................................................................... 12 Work and Benefit Status................................................................................................................ 12 Medicare .......................................................................................................................................... 13 Medicare Set Aside ....................................................................................................................... 14 MSA Settlement Process ............................................................................................................... 15 Conditional Payment of Medicare Lien .......................................................................................... 16 File Documentation for Medicare Lien .......................................................................................... 16 3TM Medicare Documentation in Claims .......................................................................................... 17 Deductible Recovery Module ........................................................................................................... 19 EDI Process ....................................................................................................................................... 20 FROI .............................................................................................................................................. 20 SROI .............................................................................................................................................. 21 Permanent Partial Disability / Maximum Medical Improvement ................................................... 25 Denial ............................................................................................................................................ 25 Settlement .................................................................................................................................... 27 State Specific Requirements .......................................................................................................... 27 3TM Automatic EDI diary triggers set in Claims ................................................................................. 29 Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 3 Overview This guide provides instruction for updating Workers’ Compensation specific data fields. Contact NARS’ Training Department at [email protected] with any questions. Data Accessed through the “Details” tab of the Summary page Several data fields can be accessed through the “Details” tab of the “Summary” screen. Policy Type The “Type” is used to reflect the nature of the claim and should be updated as facts of the loss change. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 4 Jurisdiction Claim # The “Jurisdiction Claim #” field is used to add a claim number assigned by the state agency overseeing Workers’ Compensation claims. NOTE: A “Required Fields” prompt may appear. If so, add “N/A” if no state claim number has been assigned. This field can be updated once the state claim number is assigned by the appropriate state agency. Denial If a claim has been denied, check the “Denied” box. Once the box is checked, a box entitled “Deny Claim” will appear. Add the basis for denial in the freeform field. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 5 Subrogation Click the “Subrogate” tab if there is any subrogation potential. See the Subrogation guide in NARS University Resources for additional details. Disputed Case/Controverted Select the appropriate option based on the individual claim. Check the “Denial” box if the claim is being denied and complete all the data fields in this section. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 6 Check the “Suspension” box if benefits have been suspended. Then, complete the data fields in this section. Check the “Compensable” box to show compensability determination from drop down, date of determination and rationale of determination. See the SIU Guide in NARS University for details on completing an SIU referral. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 7 Data Accessed through the Claim Tree Loss Information “Loss Information” fields indicate the location and jurisdiction of the loss. The NCCI reporting fields include “Cause of Loss,” “Nature of Injury,” and “Part of Body.” Click the magnifying glass next to the address to link to Google Earth/Google Maps. Complete all fields in yellow and update information as it is developed. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 8 The “Type of Loss” code needs to be updated to reflect the appropriate nature of the loss. Injured Worker The “Injured Worker” branch of the Claim Tree contains information on the injured workers’ demographics, employment, and earnings information. Demographic information for the injured worker includes full name, Social Security Number, gender, marital status, date of birth, complete address, phone number, and email address. All fields should be completed as information is developed. Like all claim party screens, there are multiple options available to add additional addresses and phone numbers. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 9 The “Primary Employment” section contains information on the employee. All fields should be updated as information is developed. The “Financial” section includes information on salary status and average weekly wage. NOTE: The information detailed in the “Average Weekly Wage” field is populated to the “Estimate Worksheet Calculations” data field for computation of projected exposure. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 10 Each section of the “Estimate Worksheet Calculations” sheet can be expanded by using caret arrow, so reserves can be set in each category. Complete the “Class Code” data field to reflect the injured worker’s job description. This is in the “Financial” section. Click the arrow next to the “Class Code” field for a list of potential codes and job descriptions. Choose the correct class code based on the injured worker’s job description. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 11 Primary Employer Data Fields The Primary Employer data fields include demographic information about the employer. Include contact information for the employer as information is developed. Like with all party screens, there are multiple options available to add addresses and phone numbers. We also need to complete the field for the date the employer “had knowledge of disability date” Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 12 Medical Management Field The “Medical Management” field is used to designate both status of care and plans for treatment. To add a treatment plan, use the icon to create a “Treatment Plan” note. Work and Benefit Status The “Work and Benefit Status” field is used to designate the work or work capability status and time periods for that or those statuses. The top section of the field contains information on the work and medical status of the injured worker. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 13 The bottom section contains the status type and the duration of time for each status. Update “Return to Work” status with button: Use the button to adjust status based on medical finding or actual return to work. Medicare Under provision of Section 42 CFG 411.24(e), Medicare “has a direct right of action against any ‘entity’ that has the primary responsibility to pay for medical expenses as a result of a work injury and to recover its payments from any entity which receives payment”. In addition, Medicare has “the right of subrogation against the employer, insurance company, TPA” or whoever else is responsible to pay the settlement. With that in mind, it is important to ensure the Medicare data fields are complete and accurate. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 14 The “Medicare” tab is located within the injured worker party screen. Medicare will make a “Conditional Payment” when timely payment by a primary payer, such as a TPA, is not expected. Medicare (CMS) will expect to be reimbursed. This is known as a “Medicare Lien.” Medicare Set Aside There are two classes of beneficiaries where we need to recognize Medicare’s interests: • Class I: Over 65 years of age, on Social Security Disability Insurance (SSDI) for 24 months or longer, or suffering from end stage renal disease • Class II: On SSDI and not Medicare eligible, applied for or denied SSDIB, 62 ½ years of age, permanent total disability claim, no return to work in 12 months or longer, or a “reasonable expectation” of Medicare enrollment within 30 months of settlement date. A “reasonable expectation” would include claims where the indemnity reserve is more than $100,000 or if the injured worker is an SSDI applicant and meets the above criteria. NOTE: When injured worker contact is initially made, inquiry should be made as to whether they are a Medicare beneficiary. • Center for Medicare and Medicaid Services (CMS) will not review settlement of a Class I beneficiary if the value of the settlement is less than $25,000 Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 15 • CMS will not review settlement of a Class II beneficiary if the value of the settlement is less than $250,000 Note: It is important to know if any future medicals are going to be closed by the settlement, which is a full and final settlement, and the claim will not be open for payment of future medical costs. If so, a Medicare Set Aside may be needed to protect the interests of Medicare. MSA Settlement Process 1. Identify if the injured party is a Medicare Beneficiary 2. Evaluate the settlement type 3. Determine the settlement value 4. Determine if an MSA is needed 5. Refer to an MSA vendor 6. Send documents and records to the MSA vendor 7. Obtain releases from the injured worker 8. Review MSA allocation projections The MSA allocation projection should contain anticipation costs of medical care based on the injury, established by medical records contained in the claim file. Approved medical care or services would be consistent with the care and services normally approved under the appropriate state statute. Once the MSA projection report is received, the process is as follows: The final settlement documents should be sent to CMS by the MSA vendor. Once submitted, final approval by CMS could take anywhere from 3 to 6 months. Advise the injured worker or their counsel of the anticipated time for final settlement of the claim due to review by CMS. When CMS has approved the MSA (with or without modifications), the matter is ready for finalization. Final settlement paperwork should then be submitted to CMS. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 16 Conditional Payment of Medicare Lien If the Medicare beneficiary is on Medicare and there were payments made by Medicare from the date of injury, the following tasks need to be performed: 1. Secure the signed release forms from the injured worker to obtain information from Medicare on any payments made. 2. Request an estimated conditional payment. Once it is received, analyze it to ensure the items are related to the industrial loss. Any unrelated payments should be challenged. 3. Obtain the final settlement document and submit to the Medicare Secondary Payer Recovery Center (MSPRC). CMS will consolidate all functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries into one MSP recovery contract. 4. MSPRC will take over new MSP recovery cases and most existing ones. 5. Request and analyze the final demand and make recommendation to the client. File Documentation for Medicare Lien Since an MSA is part of a settlement, the documents will be so coded in C3 as “***MARJI…***”. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 17 Medicare Documentation in Claims3TM When closing a claim, several data fields in the “Medicare” tab need to be completed. Review ICD codes to ensure codes reflect only conditions accepted as compensable. ICD codes should be updated as the medical conditions change. Codes are added by using the button and codes are removed by using the button. The is used to reload or refresh the list as updates are made. Complete the “ORM” field to detail liability for ongoing medical care. Once the box is checked, the data fields become available for completion. Once we confirm the date when our responsibility for medical charges ends, add this date to the “Termination Date” field. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 18 “Closure without ORM Termination” is used when we retain responsibility for costs of medical care. The “TPOC” section is used to show whether there was a settlement. If so, include the date and amount of the settlement in this section. When the is clicked, a drop-down menu will appear to confirm whether there was settlement of the claim. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 19 Complete “Medicare Part A & B Lien” data fields if a Medicare lien has been received or a Conditional Payment Lien has been received. Deductible Recovery Module The adjuster needs to complete a few pieces of information in the Deductible Recovery module. First, click on “Open File: Then, input the “Deductible” and “Deductible Type” and select “Save”. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 20 EDI Process Electronic Data Interchange (EDI) is the means by which forms, and filings are transmitted to the various industrial boards and commissions nationwide. Essential key information must be input into the claims program/system for this process to be completed. This module will provide instructions on the “must have” information and where in the NARS system it should be input in order to prevent late filings or penalties. FROI 3TM 1. An automatic diary is triggered for the EDI team once a new claim is entered in Claims 2. The EDI team will determine the state requirements 3. The EDI team files the FROI 4. FROI – In states where Medical Only is not reported, use diary code 4035 – Initial Indemnity Payment is the trigger to the EDI team to send a FROI, and then report the initial payment (IP) Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 21 SROI Once an initial payment is made: 1. Set a diary code 300 for the EDI specialist by jurisdiction (see below) and be sure the information is 3TM populated in the applicable fields within Claims 2. Adjusters – For states requiring paper filings, create a 300 diary to notify that a completed paper form is available in “State Forms” folder for submission Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 22 3. Adjusters – All forms required to be mailed to the injured worker, employer or other party as determined by state guidelines are completed by the adjuster and emailed to the Mailroom for mailing 4. Adjusters – Once the work status is initially obtained, or when it changes, populate the “Work & Benefit Status” screen in Claims3TM to trigger an EDI diary. NOTE: Detailed return to work information helps, i.e., employer is, or is not, accommodating, actual return to work dates, termination dates, injured worker resigned, etc. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 23 5. Enter details in applicable fields, listed below. This will help the EDI specialist complete the EDI process without emails. Information needed for the OP/IP Initial Date of Disability (RTW Screen>RTW fields) Average Weekly Wage and Calculated Weekly Wage (IW Screen>Financials) First date of disability after the Waiting Period (Loss Information Screen>Details) Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 24 Date Administrator knew disability exceeded the Waiting Period (Details Screen>Claim Administrator) Date employer was notified or became aware of injured worker’s disability (Employer Screen>Details) Days worked per week (Injured Worker screen>Employment) Hire date (Injured Worker screen>Employment) Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 25 Permanent Partial Disability / Maximum Medical Improvement Check appropriate boxes (Medical Management screen>Maximum Medical Improvement) Denial Check “Denial” box (Detail screen>Disputed Case/Controverted) then enter the following information. Once completed, this will trigger an automatic 4110 diary. 1. “Type” from drop down 2. “Effective” date from calendar Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 26 3. “Code” from drop down 4. “Reason Narrative” Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 27 Settlement Enter “Settlement Type” from drop down and “Award/Order Date” (Details>Claim Administrator) State Specific Requirements For PA, MA and NY we will need to know if we are accepting with or without liability (Injured Worker screen>Employment>Compensation Agreement) – use drop down Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 28 For IA we will need to complete fields for number of dependents and number of entitled exemptions (Injured Worker screen>Employment) For IA we will also need to complete the “Marial Status” field from drop down (Injured Worker screen>Personal Information) For WI – adjusters are responsible for login to the state website and complete all requested documents For AR, the adjuster needs to inform Susan Chandler immediately after the investigation reveals a hint of disability as the 10-day clock begins. AR1 requirements • The 10 days to report an indemnity claim begin either on the initial date of disability or the date the employer was notified of disability, whichever date is later AR2 requirements th • The first payment is due to the employee by the fifteenth (15 ) day after the notice or death or alleged injury Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Workers’ Compensation Data Fields 29 th • An AR2 is due in all cases by the fifteenth (15 ) day from (a) date of disability or (b) the day the employer is aware of the alleged incident, whichever date is later • Please send us the ARW wage form as soon as it’s received from the employer For AR forms EDI needs: • The initial date of disability • Last day worked • Waiting period dates • Average Weekly Wage/Compensation rate • ARW wage form ***NOTE: There is up to a $500.00 fine for untimely filing of forms*** 3TM Automatic EDI diary triggers set in Claims New WC claim 225 Claim Denied 4110 Add WC Return to Work Status 4030 Change WC Return to Work Status 4030 Delete WC Return to Work Status 4030 Close Claim 255 Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Pa Litigation Module and Litigation Documentation FAQS

Litigation 2 Table of Contents Overview .................................................................................................................................................. 3 Opening the Litigation Module ............................................................................................................ 3 Updating the Litigation Module ........................................................................................................... 6 Litigation Documentation FAQs ........................................................................................................... 7 Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 3 Overview When notice of pending litigation is received, the Litigation Module should be opened and updated. This document demonstrates how to open and update the Litigation Module. Additionally, we have included valuable litigation documentation FAQs. Contact NARS’ Training Department at [email protected] with any questions. Opening the Litigation Module Upon receipt of a Summons and Complaint or similar legal document, move the document to the “Legal” folder. This generates a dairy code 142, which is sent to a Customer Service Representative (CSR) to open the Litigation Module. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 4 A CSR opens the Litigation Module through the claim “Details” tab by clicking the “Litigate” icon. Once selected, the “Create New Legal File” window appears. The CSR will complete as much information as possible including the Style Name, Court Name, Docket #, Suit Filed Date and Prayer $ (if indicated) and click “OK”. The Claim Tree populates with a branch entitled “Litigation” with the style name beneath it. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 5 Double-click the style name, and the Litigation Module opens to the “Summary” tab. The CSR will add the Service date as well as Plaintiff and Defendant information on the “Summary” tab. The CSR will also update the “Parties” tab by adding the Plaintiff, Plaintiff’s attorney, Defendant and Defendant’s attorney. The adjuster is responsible for entering all other information in the Litigation Module. This includes “Liability”, “Settlement/Negotiations”, “Pre-Trial”, “Trial” and “Appeals” tabs, as applicable. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 6 Updating the Litigation Module Click the green plus sign in the “Liability” tab to create a new Liability Disposition. Select “Continue Discovery”, “Defend”, or “Settle” according to client-specific litigation guidelines. Click the green plus sign in the “Pre-Trial” folder to create new trial activities. Complete as much information as possible. In the “Trial Folder”, add “Trial Stages” and “Verdicts”. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 7 Use the “Appeal” tab as appropriate. Note: It is the CSR’s responsibility to open the Litigation Module and enter as much information in the “Summary” and “Parties” tabs as possible based on the Summons and Complaint. The Summons and Complaint must be placed in the “Legal” folder for the CSR. The Adjuster is responsible for adding additional information and updating all other tabs with appropriate dates. Reports are run from the information entered including dates for hearings, mediations, trials, etc. Consistently and accurately using the Litigation Module will assist you and NARS with organizing all aspects of litigated claims. Litigation Documentation FAQs What type of mail is considered “Litigation Documentation”? Pleadings including Summons and Complaint, Notice of Petition, Notice of Hearing, Defense Counsel status reports, Mediation notice/order, Mandatory Settlement Conferences, Pre-Trial Conference Notices/Orders, Trial notices, Scheduling or Tracking Orders. These documents should be placed in the appropriate folders beneath the “Legal” folder. If new legal mail is received via email, how do I place it the file? Emailed legal documents can be added to any of the Legal folders in C3™ by dragging and dropping emails, emails with attachments or attachments only into the appropriate C3™ folder. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.

Litigation 8 Ensure documents are properly labeled for easy identification including the name of the sender as well as a summary of the document. For example, Defense attorney, Joe Smith re: upcoming mediation date. Include a detailed summary of the document in the note section. A file note will be created with your summary and a link to the document. If the document is a Summons and Complaint and a Litigation Module needs to be opened, add the Summons and Complaint to the “Legal” folder to create a 142 diary. Confirm the document is labeled “Summons and Complaint” and include the filing and service dates. The CSR will move the Summons and Complaint to the Summons and Complaint folder once the Litigation screen is created. Is the Litigation Module audited by QA and Management? Yes, and the adjuster will be audited on the content and use of the Litigation Module. Who moves and labels legal documents within the C3™ claim file? The adjuster is responsible for placing legal documents into appropriate folders. See above for an example of appropriate document labeling. Does the adjuster have to request the Litigation module be opened for them? No, adjusters may create the Litigation Module themselves by following the instructions above. If you complete the Litigation Module, conclude any 142 code diaries to avoid confusion. Confidential, Proprietary and Trade Secret Document of NARS and protected by the Florida Uniform Trade Secrets Act, chapter 688, Florida Statutes. No use allowed unless specifically authorized.