Workers compensation monitoring program tony taras 800 782 5888 ext 1678 ataras@ceo lacounty gov
Download
1 / 18

County Code 5.31.050 Workers’ Compensation System - PowerPoint PPT Presentation


  • 126 Views
  • Uploaded on

WORKERS’ COMPENSATION MONITORING PROGRAM TONY TARAS (800) 782-5888 ext 1678 [email protected] County Code 5.31.050 Workers’ Compensation System. Report, investigate, and adjust claims. Determine compensability and pay benefits. Collect and report statistical data.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' County Code 5.31.050 Workers’ Compensation System' - gillespie-hehir


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

County Code 5.31.050Workers’ Compensation System

  • Report, investigate, and adjust claims.

  • Determine compensability and pay benefits.

  • Collect and report statistical data.

  • Establish and review reserves.

  • “Control…workers’ compensation costs consistent with full provision of benefits under the law.”


TPA CONTRACTS –TECHNICAL EXHIBIT I

WORKERS’ COMPENSATION PROGRAM

“The primary objective of this program is to provide all workers’ compensation benefits required under State law to injured County employees on a timely basis, at the least possible cost to the County.”


Tristar rancho unit 1
TRISTAR – RANCHO (UNIT 1)

MANAGER: KAREN SATURDAY

(800) 782-5888 ext 1683

[email protected]

MONITORS: MARK LEBLANC

(800) 782-5888 ext 1648

[email protected]

TONI VU

(800) 782-5888 ext 1769

[email protected]


Tristar rancho unit 2
TRISTAR – RANCHO (UNIT 2)

MANAGER: OLA OLIFESO

(800) 782-5888 ext 1152

[email protected]

MONITOR: ROSE BLOOM

(800) 782-5888 ext 1676

[email protected]


Intercare unit 3
INTERCARE (UNIT 3)

MANAGER: KATHLEEN BURRIS

(866) 221-2968 ext 430

[email protected]

MONITORS: JOE CARRILLO

(866) 221-2968 ext 422

[email protected]

PAM KENNEDY

(866) 221-2968 ext 421

[email protected]


Aims unit 4
AIMS (UNIT 4)

MANAGER: CHERYL AGEE

(661) 705-2908

[email protected]

MONITOR: ERNIE ROMO

(661) 705-2905

[email protected]


“The Quality Assurance Evaluator is a County employee designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”


Duties of the county monitor
DUTIES OF THE COUNTY MONITOR designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

  • Review all delayed claims at 30/60/90 day intervals

  • Approve all litigation referrals to County Counsel

  • Approve all award payments

  • Approve all payments over $7,500.00

  • Provide training to TPA staff


Duties of the county monitor1
DUTIES OF THE COUNTY MONITOR designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

  • Assist TPA staff on balancing of complex cases

  • Analyze claims and provide settlement recommendations and authority

  • Address questions and concerns of injured workers, County departments, and defense attorneys

  • Attend claim reviews

  • Conduct annual audit of the TPA’s


Liaison between departments and third party administrators
LIAISON BETWEEN DEPARTMENTS AND THIRD PARTY ADMINISTRATORS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”


Claim reviews
CLAIM REVIEWS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

  • Reviews should be held at least quarterly with County Monitors, CEO RTW personnel, Departmental RTW personnel, Loss Control, and County Counsel.

  • Don’t overload! If necessary, schedule more frequent claim reviews.


Claim reviews1
CLAIM REVIEWS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

File Selection:

  • Choose files with complex claims or RTW issues.

  • Get input from your TPA’s, County Monitors, and Counsel.

  • “Out of service” does not mean “out of sight, out of mind”!


Claim reviews2
CLAIM REVIEWS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

What we need from you:

  • Information about any RTW efforts that have been made

  • Information about any disciplinary action being taken against the injured worker (unless confidential)

  • Information about any other action the injured worker is taking against the County (unless confidential)

  • Type of retirement plan

  • Out of service date and termination reason, if any


Annual tpa audits
ANNUAL TPA AUDITS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

  • We randomly select 80 files to audit TPA performance during a defined period.

  • TPA’s are scored on 37 questions assigned weights based on level of importance.

  • A total score is calculated based on the weighted scores in each category.

  • There are “mutually beneficial performance and financial incentives” applied based on the total score.


Annual tpa audits1
ANNUAL TPA AUDITS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”

CHANGES IN 2009:

  • Vocational rehabilitation questions have been eliminated

  • New questions on:

    • State Panel QME Process

    • Supplemental Job Displacement

    • Work Restriction Letters


Work restriction letters

WORK RESTRICTION LETTERS designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”


Questions

QUESTIONS? designated as an agent for the County responsible for monitoring the Contractor’s performance, approving over limit payments, advising and training third party administrator staff in County payroll systems and other County procedures. At times this employee may be referred to as ‘County Monitor’.”


ad