Claims Management Services. The Association agrees to provide the following services, and may elect to do so through the engagement of a professional claim management firm:
Claims Management Services. In satisfaction of its obligations to assist the Insurer with the processing of claims arising under policies reinsured in connection with the Group Short Term Disability Reinsurance Treaty (“the Treaty”), the Reinsurer designates Claims Service International, Inc. (“CSI”) to perform claims management services in connection with the Treaty as set forth herein. The Insurer shall not be liable to CSI for the services rendered under the Claims Management Agreement and shall not bear any of the expenses incurred by CSI in connection with CSI’s performance of services hereunder, except as may be expressly set forth herein. The obligation of CSI to perform administrative services in connection with the Treaty shall continue until such time as all reinsured claims have been paid, unless other agreement is reached and becomes a written part of this Agreement.
Claims Management Services. (A) General:
Claims Management Services including (i) receipt, processing, settlement and payment of claims in states other than Alaska, Idaho, Montana, Oregon and Washington under the policies and contracts of workers compensation insurance issued by Agency Markets pursuant to requests from Agency Markets (the “Portfolio”); (ii) acknowledgement of the receipt of notices received from policyholders in connection with any claims; (iii) investigation of any claim, as necessary, to determine its validity and compensability, including verification of coverage and status information and utilization of any relevant documents and/or information made available to Liberty Mutual and advice to the appropriate person of the results of such investigation; (iv) notification to policyholders of declined claims and the reasons for such declinations; (v) response to any inquiry, complaint or request received from any policyholder, agent, broker, regulator or other interested party pertaining to or regarding any such claim, and recordation of such complaints in complaint logs to be maintained by Liberty Mutual on Agency Markets’ behalf; (vi) compliance with claims file maintenance, record retention and reconciliation requirements in conformity with the standards for performance set forth in this Service Agreement or as otherwise agreed by the parties; (vii) engagement and direction, as necessary, of attorneys, consultants or other professionals in connection with the processing, defense and handling or any such claims; (viii) defense of disputed claims; (ix) delivery of notices and other communications to policyholders; and (x) generally, all such other acts and things as are reasonably necessary or otherwise required in the administration of all such claims relating to the Portfolio;
Claims Management Services. Database and System Access (No restriction on number of users) Data Transfer Manual Claims Input Document Storage $ .10 per record per month $ .10 per creditor $ .25 per claim (plus hourly rates) Waived Call Center Services Standard Call Center Setup Call Center Operator Voice Recorded Message Support/Maintenance $2,500 $75 per hour $0.19 per minute $200 per month Additional call center services not specifically covered by this proposal will be charged at hourly rates or at a unit price to be determined. Specifically, such tasks as reviewing and managing traffic reports, assigning and supervising staff, call auditing, quality control testing, training and the like will be billed at the applicable hourly rate.
Claims Management Services including (i) receipt, processing, settlement and payment of claims under the policies and contracts of insurance issued by Wausau pursuant to requests from PIC (the “Portfolio”); (ii) acknowledgement of the receipt of notices received from policyholders in connection with any claims; (iii) investigation of any claim, as necessary, to determine its validity and compensability, including verification of coverage and status information and utilization of any relevant documents and/or information made available to Wausau and advice to the appropriate person of the results of such investigation; (iv) notification to policyholders of declined claims and the reasons for such declinations; (v) response to any inquiry, compliant or request received from any policyholder, agent, broker, regulator or other interested party pertaining to or regarding any such claim, and recordation of such complaints in complaint logs to be maintained by Wausau; (vi) to the extent required by law, provision to policyholders of reports on taxable benefits, and the amounts withheld on account of FICA, federal, state and/or local income taxes, both as payments of benefits are made, and as of the end of each calendar or fiscal year; (vii) compliance with claims file maintenance, record retention and reconciliation requirements in conformity with the standards for performance set forth in this Service Agreement or as otherwise agreed by the parties; (viii) engagement and direction, as necessary, of attorneys, consultants or other professionals in connection with the processing, defense and handling or any such claims; (ix) defense or disputed claims; (x) delivery of notices and other communications to policyholders; and (xi) generally, all such other acts and things as are reasonably necessary or otherwise required in the administration of all such claims relating to the Portfolio;
Claims Management Services a. Assist the Judicial Council in management of claims, to their conclusion, for no additional fees by providing the full range of claims services.
