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.