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.