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.