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.