Workers’ Compensation Services. The Agency will provide a quarterly summary for all xxxxxxxx associated with WSBC and workers’ compensation agencies of other provinces. The Agency will remit any and all additional payments it receives from workers’ compensation agencies for workers’ compensation xxxxxxxx over and above the applicable hourly rate under this Contract to each Physician individually on a quarterly basis including any premiums and other payments negotiated in any fee for service agreements between WSBC and the Doctors of BC. For clarity, these quarterly payments will be made once the funds are actually received from the workers’ compensation agencies and reconciled with xxxxxxxx by the Agency. For additional clarity, payment will not become due and owing to a Physician until that Physician has submitted the required reporting form(s) and invoice(s) in accordance with APPENDIX 4. For further clarity, only OR and OOR Services provided on the Site are eligible for pay.
4. Payment – Collective
(a) Clinical Administrative Services
Workers’ Compensation Services. The Authority shall, when chosen by the injured worker:
(i) Provide initial evaluations of occupational injuries or diseases and infectious and toxic exposures for all City employees, except in conflict of interest cases. The initial evaluation report shall include a complete and thorough, unbiased history and systems review with regard to causation, which is defined as whether the mechanism of injury is consistent with the reported accident, exposure, or job duties of the City employee. The report of each evaluation shall include time-defined, goal-oriented medical care and treatment plans that return the employee to work as soon as medically reasonable. The initial evaluation shall contain a specific statement addressing the physician’s opinion on causality. In this statement of causality, the physician shall explain the link between the mechanism of injury, the patient’s complaints and the work duties of the patient with a reasonable degree of a medical probability as required by Colorado state law. If further information such as a description of work duties, witness statements, etc. is required to evaluate causality, the physician will indicate this in his/her statement of causality. Causality will be addressed for each body part involved in the injury event. If causality is not determinable at the initial visit, the physician will address it at each subsequent visit until a conclusion is reached. The physician will not make unnecessary referrals for determination of causation and will take responsibility for his/her own causation analysis.
(ii) Manage the medical care provided by all physicians by whom treatment is provided to City employees, whether these services are directed (a) by the Center for Occupational Safety and Health (COSH), or (b) by a physician, clinic or provider to whom the employee has been referred by the COSH.
(iii) Communicate effectively with all persons in the City with whom communication is necessary for the management of its employees, including but not limited to the Risk Management Office, the City Attorney’s Office, and managers and supervisors of the various agencies and departments.
(iv) The management of the list of Specialist Consultants will be the responsibility of COSH. In non-emergent situations, when the Primary Occupational Physician at the Authority believes that the best interests of the City employee will be met only by utilizing a Consult Specialist not on the Level II Provider list, a justification will be pr...
