General: 1. Provide claims administration services for workers’ compensation cases and no-fault commercial automobile claims. 2. Maintain files and records for all claims files including adjuster claim notes. 3. Maintain records necessary for the defense of the claims at Workers’ Compensation Board hearings. 4. Aggressively pursue relief from the Special Funds (i.e.: WCL §§15-8, 25-A, 14-6, etc.) and identify, and conduct, subrogation activities and pursue third party liens. 5. Provide necessary notification to all excess carriers on claims which threaten the selfinsured retention levels. 6. Provide claim loss and management reports on a monthly, quarterly and annual basis. These reports must be issued on both a paid and incurred basis. Executive summaries must also be provided as requested by the TOWN. Claims Services for workers’ compensation claims: 1. Examine and review all workers’ compensation claims submitted. Create and maintain a file for each claim. Determine, analyze and evaluate the claim, determine validity and compensability, and advise the TOWN of your findings. 2. Estimated value for each case and set the appropriate reserve. 3. Conduct early intervention and preliminary investigations on all claims to determine their validity. 4. Ensure that all submitted claims for medical services and medications meet authorized WCL fee schedules. 5. Utilize appropriate medical personnel to review claimant’s treatment plans and ensure that the treatments are related to the claimed injury. 6. Review all prescription medications claimed by the employee or former employee to ensure that the prescriptions paid by the TOWN are related to the claimed injury. 7. Prepare and file all required forms with the New York State Workers’ Compensation Board, and all forms relating to other local, state or federal requirements, including, but not limited to HIPAA and the Health Care Reform Act of 2000 (HCRA). 8. Regularly contact and maintain communication with the Attorney representing the Town at Workers’ Compensation Board hearings. Attorney’s representing the TOWN will be selected and/or approved by the TOWN. 9. Prepare the files for the defense of the claim at Workers’ Compensation Board hearings.
