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.