Scope of Services Claims Administration Examine all claims reported and determine if the claim is compensable under Connecticut Workers Compensation laws, including newly enacted provisions for PTSD and the Firefighter Cancer Relief Program, as well as newly enacted provisions during the period of the TPA agreement. Services shall include the following core services: a. On-line reporting claim ability as well as a toll free, 24 hours per day, seven days a week telephone number for Town supervisors to report work related injuries or illnesses. b. On Line Claims Portal to be accessed by the Town for claim information, including adjuster notes, reserves, payments and loss runs. c. Assume all open claims existing at the beginning of the contract term and handle any re-opened claims and follow them through closure. Investigate and handle all newly reported claims. d. Contact the injured employee within 24 hours for a Lost Time claim and 48 hours for a Medical Only claim. e. Manage Medical Only Claims to reduce the risk of becoming a Lost Time claim. f. Obtain and review all medical reports and bills related to the claim and establish if the fees charged are reasonable and customary. g. Establish and maintain a high-quality workers compensation managed care plan. h. Maintain accurate case reserves. i. Payments to claimants and providers will be made by the TPA on behalf of the Town. All cash flow provisions will be mutually agreed to between the Town and the administrator including weekly internal payroll vouchers. j. Report and monitor claims to the excess carrier in accordance with excess policy requirements.
