Common use of Ongoing Reporting Requirements Clause in Contracts

Ongoing Reporting Requirements. 1. The County considers that automatic monthly status reports in the absence of new information or activity are duplicative, redundant and unnecessarily increase litigation costs. As such, the assigned attorney shall use discretion as to submission of subsequent status reports to the TPA (with a copy to the County’s Workers’ Compensation Program Manager) and do so only when the activities of file events warrant. Letters directed to Applicant’s attorney do not require a separate letter to the TPA/County reiterating the content of the attorney correspondence. County/TPA will not pay for duplicative or unnecessary information. 2. Depositions of the Applicant, if warranted, must be scheduled within five (5) business days of the opening letter. 3. Upon direction from the Claims Examiner to utilize an Agreed Medical Examiner (AME), a list of ▇▇▇▇ from the County’s panel must be forwarded to the Applicant’s attorney within five (5) business days. 4. Upon direction from the Claims Examiner to utilize a Panel Qualified Medical Evaluator (PQME), the panel must be requested within five (5) business days. In order to avoid delays for claims that require multi-specialty Med Legal evaluations, the assigned attorney should be setting all appointments for each specialty at the same time, rather than waiting for receipt of one Med Legal and then proceeding to schedule the other(s). 5. It is expected that the assigned attorney will schedule a conference call with the Claims 6. Legal correspondence shall be provided to the County and TPA within the following timeframes: • Hearing Reports: fourteen (14) calendar days from the date of hearing (Mandatory Settlement Conference (MSC), Expedited, Status Conference, Trial, etc.) • Pre-trial/WCAB hearing discussion shall take place with the Claims Examiner five (5) business days before the calendared date to make sure defense counsel has everything needed prior to the hearing. • If benefits are due as a result of a hearing, defense counsel must notify the examiner within two (2) business days to avoid penalty exposure. 7. Requests for further discovery (e.g., photocopy of records, client documents, investigation/surveillance, deposition, medical-legal evaluations, appeals) shall be directed to the TPA Claims Examiner by email with a copy to ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ (the entity responsible for the central scanning for the claim file). 8. Defense attorney should obtain authority on any proposed stipulations and or agreements that impact claim handling from the Workers’ Compensation Program Manager and TPA/ Claim Examiner and or TPA Unit manager. 9. Requests for settlement authorizations shall be emailed to the Claims Examiner with a copy to the Unit Manager and the TPA Program Manager as well as the County’s Workers’ Compensation Program Manager. “Request for Settlement Authorization” shall be noted in the subject line of the email. 10. Once authorization is received, the assigned attorney must conclude settlement negotiations within twenty (20) business days or notify Claims Examiner and County’s Workers’ Compensation Program Manager in writing why a settlement was not reached and an estimated date to reach a settlement with a plan of action as to how he/she will accomplish this. 11. If there is no response from the Claims Examiner to any written or verbal request for information and/or required authorization within a (15) fifteen- day period, the assigned attorney shall escalate to the Claims Examiner’s manager. 12. Time-sensitive documents shall be emailed to the Claims Examiner with a copy to the 13. Within ten (10) business days of receipt of maximal medical improvement (MMI)/permanent and stationary (P&S) report, the assigned attorney must request settlement authority with a full analysis of the claim or notify Claims Examiner and the County’s Workers’ Compensation Program Manager why the claim is not in posture for settlement. 14. After claim resolution, authorization from the TPA is required for any further attorney involvement. 15. Post-claim resolution or when approached by a lien claimant with a settlement demand, the assigned attorney shall seek direction from the Claims Examiner as to whether the lien(s) will be resolved by the attorney or by the TPA. If handled by the TPA, the Claims Examiner may request the assigned attorney, or an approved external vendor attend any lien hearings at the Workers’ Compensation Appeals Board (WCAB). 16. A Litigation Management Report shall be completed by the assigned attorney on each open file that they maintain in their caseload using the Litigation Management template provided by the TPA and approved by the County. A separate spreadsheet shall be updated which includes all applicants that are separated from the County along with a plan of action to obtain a settlement, preferably a Compromise and Release. The Litigation Management report is due on files 180-days from the initial assignment date and due every 180 days thereafter. All updates shall include a litigation budget update. If a specific firm and/or their attorney does not report timely, the requirement can be changed to 90 days to ensure there is adequate reporting. This would be at the discretion of the TPA and the County’s Workers’ Compensation Program Manager.

Ongoing Reporting Requirements. 1. The County considers that automatic monthly status reports in the absence of new information or activity are duplicative, redundant and unnecessarily increase litigation costs. As such, the assigned attorney shall use discretion as to submission of subsequent status reports to the TPA (with a copy to the County’s Workers’ Compensation Program Manager) and do so only when the activities of file events warrant. Letters directed to Applicant’s attorney do not require a separate letter to the TPA/County reiterating the content of the attorney correspondence. County/TPA will not pay for duplicative or unnecessary information. 2. Depositions of the Applicant, if warranted, must be scheduled within five (5) business days of the opening letter. 3. Upon direction from the Claims Examiner to utilize an Agreed Medical Examiner (AME), a list of ▇▇▇▇ from the County’s panel must be forwarded to the Applicant’s attorney within five (5) business days. 4. Upon direction from the Claims Examiner to utilize a Panel Qualified Medical Evaluator (PQME), the panel must be requested within five (5) business days. In order to avoid delays for claims that require multi-specialty Med Legal evaluations, the assigned attorney should be setting all appointments for each specialty at the same time, rather than waiting for receipt of one Med Legal and then proceeding to schedule the other(s).should 5. It is expected that the assigned attorney will schedule a conference call with the ClaimsClaims Examiner, Unit Manager and County’s Workers’ Compensation Program Manager when collaboration is needed to develop or clarify the plan of action. It is also expected that the assigned attorney(s) will make themselves available for conference calls upon request by either the TPA or the County. 6. Legal correspondence shall be provided to the County and TPA within the following timeframes: • Hearing Reports: fourteen (14) calendar days from the date of hearing (Mandatory Settlement Conference (MSC), Expedited, Status Conference, Trial, etc.) • Pre-trial/WCAB hearing discussion shall take place with the Claims Examiner five (5) business days before the calendared date to make sure defense counsel has everything needed prior to the hearing. • If benefits are due as a result of a hearing, defense counsel must notify the examiner within two (2) business days to avoid penalty exposure. 7. Requests for further discovery (e.g., photocopy of records, client documents, investigation/surveillance, deposition, medical-legal evaluations, appeals) shall be directed to the TPA Claims Examiner by email with a copy to ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ (the entity responsible for the central scanning for the claim file). 8. Defense attorney should obtain authority on any proposed stipulations and or agreements that impact claim handling from the Workers’ Compensation Program Manager and TPA/ Claim Examiner and or TPA Unit manager. 9. Requests for settlement authorizations shall be emailed to the Claims Examiner with a copy to the Unit Manager and the TPA Program Manager as well as the County’s Workers’ Compensation Program Manager. “Request for Settlement Authorization” shall be noted in the subject line of the email. 10. Once authorization is received, the assigned attorney must conclude settlement negotiations within twenty (20) business days or notify Claims Examiner and County’s Workers’ Compensation Program Manager in writing why a settlement was not reached and an estimated date to reach a settlement with a plan of action as to how he/she will accomplish this. 11. If there is no response from the Claims Examiner to any written or verbal request for information and/or required authorization within a (15) fifteen- day period, the assigned attorney shall escalate to the Claims Examiner’s manager. 12. Time-sensitive documents shall be emailed to the Claims Examiner with a copy to the 13. Within ten (10) business days of receipt of maximal medical improvement (MMI)/permanent and stationary (P&S) report, the assigned attorney must request settlement authority with a full analysis of the claim or notify Claims Examiner and the County’s Workers’ Compensation Program Manager why the claim is not in posture for settlement. 14. After claim resolution, authorization from the TPA is required for any further attorney involvement. 15. Post-claim resolution or when approached by a lien claimant with a settlement demand, the assigned attorney shall seek direction from the Claims Examiner as to whether the lien(s) will be resolved by the attorney or by the TPA. If handled by the TPA, the Claims Examiner may request the assigned attorney, or an approved external vendor attend any lien hearings at the Workers’ Compensation Appeals Board (WCAB). 16. A Litigation Management Report shall be completed by the assigned attorney on each open file that they maintain in their caseload using the Litigation Management template provided by the TPA and approved by the County. A separate spreadsheet shall be updated which includes all applicants that are separated from the County along with a plan of action to obtain a settlement, preferably a Compromise and Release. The Litigation Management report is due on files 180-days from the initial assignment date and due every 180 days thereafter. All updates shall include a litigation budget update. If a specific firm and/or their attorney does not report timely, the requirement can be changed to 90 days to ensure there is adequate reporting. This would be at the discretion of the TPA and the County’s Workers’ Compensation Program Manager.

Ongoing Reporting Requirements. 1. The County considers that automatic monthly status reports in the absence of new information or activity are duplicative, redundant and unnecessarily increase litigation costs. As such, the assigned attorney shall use discretion as to submission of subsequent status reports to the TPA (with a copy to the County’s Workers’ Compensation Program Manager) and do so only when the activities of file events warrant. Letters directed to Applicant’s attorney do not require a separate letter to the TPA/County reiterating the content of the attorney correspondence. County/TPA will not pay for duplicative or unnecessary information. 2. Depositions of the Applicant, if warranted, must be scheduled within five (5) business days of the opening letter. 3. Upon direction from the Claims Examiner to utilize an Agreed Medical Examiner (AME), a list of ▇▇▇▇ from the County’s panel must be forwarded to the Applicant’s attorney within five (5) business days. 4. Upon direction from the Claims Examiner to utilize a Panel Qualified Medical Evaluator (PQME), the panel must be requested within five (5) business days. In order to avoid delays for claims that require multi-specialty Med Legal evaluations, the assigned attorney should be setting all appointments for each specialty at the same time, rather than waiting for receipt of one Med Legal and then proceeding to schedule the other(s). 5. It is expected that the assigned attorney will schedule a conference call with the ClaimsClaims Examiner, Unit Manager and County’s Workers’ Compensation Program Manager when collaboration is needed to develop or clarify the plan of action. It is also expected that the 6. Legal correspondence shall be provided to the County and TPA within the following timeframes: • Hearing ReportsDeposition Summaries: fourteen (14) calendar days from the date of hearing (Mandatory Settlement Conference (MSC), Expedited, Status Conference, Trial, etc.) the scheduled deposition. • Pre-trial/WCAB hearing discussion shall take place with the Claims Examiner five (5) business days before the calendared date to make sure defense counsel has everything needed prior to the hearing. • If benefits are due as a result of a hearing, defense counsel must notify the examiner within two (2) business days to avoid penalty exposure. 7. Requests for further discovery (e.g., photocopy of records, client documents, investigation/surveillance, deposition, medical-legal evaluations, appeals) shall be directed to the TPA Claims Examiner by email with a copy to ▇▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇▇.▇▇▇ (the entity responsible for the central scanning for the claim file). 8. Defense attorney should obtain authority on any proposed stipulations and or agreements that impact claim handling from the Workers’ Compensation Program Manager and TPA/ Claim Examiner and or TPA Unit manager. 9. Requests for settlement authorizations shall be emailed to the Claims Examiner with a copy to the Unit Manager and the TPA Program Manager as well as the County’s Workers’ Compensation Program Manager. “Request for Settlement Authorization” shall be noted in the subject line of the email. 10. Once authorization is received, the assigned attorney must conclude settlement negotiations within twenty (20) business days or notify Claims Examiner and County’s Workers’ Compensation Program Manager in writing why a settlement was not reached and an estimated date to reach a settlement with a plan of action as to how he/she will accomplish this. 11. If there is no response from the Claims Examiner to any written or verbal request for information and/or required authorization within a (15) fifteen- day period, the assigned attorney shall escalate to the Claims Examiner’s manager. 12. Time-sensitive documents shall be emailed to the Claims Examiner with a copy to the 13. Within ten (10) business days of receipt of maximal medical improvement (MMI)/permanent and stationary (P&S) report, the assigned attorney must request settlement authority with a full analysis of the claim or notify Claims Examiner and the County’s Workers’ Compensation Program Manager why the claim is not in posture for settlement. 14. After claim resolution, authorization from the TPA is required for any further attorney involvement. 15. Post-claim resolution or when approached by a lien claimant with a settlement demand, the assigned attorney shall seek direction from the Claims Examiner as to whether the lien(s) will be resolved by the attorney or by the TPA. If handled by the TPA, the Claims Examiner may request the assigned attorney, or an approved external vendor attend any lien hearings at the Workers’ Compensation Appeals Board (WCAB). 16. A Litigation Management Report shall be completed by the assigned attorney on each open file that they maintain in their caseload using the Litigation Management template provided by the TPA and approved by the County. A separate spreadsheet shall be updated which includes all applicants that are separated from the County along with a plan of action to obtain a settlement, preferably a Compromise and Release. The Litigation Management report is due on files 180-days from the initial assignment date and due every 180 days thereafter. All updates shall include a litigation budget update. If a specific firm and/or their attorney does not report timely, the requirement can be changed to 90 days to ensure there is adequate reporting. This would be at the discretion of the TPA and the County’s Workers’ Compensation Program Manager.