Agenda packet — Foster City City Council, June 16, 2025 (part 2 of 5)

Submission Date – April 10, 2025

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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Response to RFP – City of Foster City
transportation expenses. This City’s outstanding reserve was reduced from $5Mil upon intake to its current $2.5 Mil, a reduction of 50%.

Should the City opt to transfer existing claims to LWP, it is likely LWP would identify opportunities for claim closure as well as reductions in treatment for future medical claims upon intake. When assuming future medical claims, we will review not only the current treatment patterns, but also the award as well as the medical reports on which the future medical award was based. It is not uncommon to find that over time, treatment has evolved beyond the scope of the award, and that bills are being “processed” rather than “adjusted”. LWP can often impact those future medical claims by either reintroducing controls, or even by lump sum settlements, if agreeable to the client.

LWP is proactive, disciplined, and we deliver results! Our tag line is not just marketing “spin”. By choosing LWP, the City will not be choosing an “administrator”. They will be choosing a “partner”. We will make it our mission to improve the City’s results by preventing litigation, by aggressively moving claims to early closure and by shutting down claims before they develop.

In particular, we recognize that we are an extension of each client’s risk management team and that improving the cost-efficiency of your program is a continuing need. Our approach is:
a) Start by tackling the issues and concerns that are currently known to the City b) Work closely with the City to analyze any additional savings opportunities that might be identified during our SWAT intake process
c) Develop and implement a plan to capture those savings d) Continue process throughout the life of the relationship LWP has read and will comply with all terms of the RFP should we be chosen as the City’s partner.

Be assured that if the City selects LWP to be their Claims Partner, we will work diligently to earn their business each and every day. We are confident that we can reduce their Workers’ Compensation claims costs while easing the process at the same time. We promise to listen to the City’s requests and needs, and to tailor our program to meet those precise requests. And above all else, LWP is known for “Delivering What We Promise!” We look forward to hearing about next steps.

Sincerely,
Judy Adlam
President & CEO
LWP Claims Solutions, Inc.
35 Miller Ave. #214
Mill Valley, CA 94941
(415) 730-7841 (cell)
[email protected]

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TableꢀofꢀContents ꢀ
ꢀ Cover Letter ..................................................................................................................................................................2 Table of Contents........................................................................................................................................................4

3. Minimum Qualifications......................................................................................................................................5

4. Firm Qualifications................................................................................................................................................8

5. Key Personnel and Staff ................................................................................................................................... 12

6. Technical Approach and Methodology...................................................................................................... 20

7. Cost Proposal................................................................................................................. under separate cover Attachments
Scope of Services...................................................................................................................................................... 34 Addenda
A. Claims Best Practices ............................................................................................................................................... 60 B. Litigation Best Practices .......................................................................................................................................... 84 C. Sample Reports ............................................................................................................................................................ 93 D. Management and Subcontractor Bios...............................................................................................................137

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3. Minimum Qualifications Respondent shall herein demonstrate that it meets the minimum qualifications by identifying and providing a narrative on how it meets each of the minimum qualifications listed below.

Respondent’s Proposal will be deemed non-responsive if these minimum qualifications are not met.

1. Respondents Claims Adjusters assigned to the City’s account shall have a minimum of five (5) years experience adjusting workers’ compensation claims and possessing a Self-Insured (SIP) Certificate plan is desirable.

LWP had not yet identified Claims Examiner candidates for the City to consider. Upon contract award, we will make one or more candidates available for the City to consider.

The Sr. Examiners will adjust indemnity claims (up to 125 pending) under the supervision of the Claims Supervisor. Authorities will be set commensurate with the City guidelines and our joint assessment of each person’s performance. When identifying candidates for the City to consider for an Examiner for the City, our standards will be:
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Minimum of 5 years Adjusting Experience
5 years’ Experience managing claims for Public Agencies Licensed Self-Insured Administrator
State Certified Examiner Status
Receptivity to the City’s program needs
Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
Candidate must also successfully pass LWP’s background checks (credit and criminal).

2. Respondents Claims Supervisor shall have a minimum of five (5) years experience handling and supervising workers’ compensation claims and possess a Self-Insured (SIP) Plan Certificate.

LWP had not yet identified the Claims Supervisor for the City to consider. Upon contract award, we will make one or more candidates available for the City to consider.

The Claims Supervisor will oversee the work of the Examiners. These team members will perform oversight diary and will review and approve delays, denials, acceptances after delay, settlements, referrals to counsel, investigators, Utilization Review, etc. When identifying candidates for the City team, we will consider the following:
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Minimum of 10 years Claims Experience
Minimum 2 years Supervisory Experience
Licensed Self-Insured Administrator
State Certified Examiner Status
Experience managing claims for Municipalities
Receptivity to the client’s program needs
Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
Candidate must successfully pass LWP’s background checks (credit and criminal).

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3. Respondent’s business shall have been in existence for at least ten (10) years providing the type of services required by the scope of services.

In business for 35 years, LWP has managed claims for public agencies since 1994.

In order to give the City assurance that we have substantial experience with similar entities, we offer the following list of public agency clients for whom we currently provide bundled claims services as proposed for the City:

City of Alameda
City of Burlingame
City of Fremont
City of Gardena
City of Hayward
City of Roseville
City of San Mateo
City of San Rafael
City of Santa Rosa
City of Sausalito
City of South Lake Tahoe
City of Torrance (conflict claims only)
City of Vallejo
City of Walnut Creek
City of Watsonville
County of Butte
County of Shasta (conflict claims only)
Pasadena Unified School District
Town of Los Gatos
PRISM PWC Members
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County of Sutter
City of Carmel-by-the-Sea
City of Lindsay
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Mt. Diablo Unified School District
Tahoe Transportation District
San Mateo Consolidated Fire District
YCPARMIA Members
• County of Yolo
City of Davis
City of West Sacramento
City of Winters
City of Woodland
Esparto Unified School District
Capay Valley Fire Protection District
Clarksburg Fire Protection District
Cottonwood Cemetery District
Davis Cemetery District
Dunnigan Fire Protection District
East Davis County Fire Protection
District
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Esparto Fire Protection District
In-Home Supportive Services Public
Authority
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Madison Community District
Madison Fire Protection District
No Man's Land Fire Protection District
Sacramento-Yolo Port District
Springlake Fire Protection District
West Plainfield Fire Protection District
Willow Oak Fire Protection District
Winters Cemetery District
Winters Fire Protection District
Woodland-Davis Clean Water Agency

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•
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Valley Clean Energy Alliance
Yolo County Habitat Conservation
Yolo County Law Library
Yolo County Local Agency Formation
Commission
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Yolo County Superior Court
Yolo Emergency Communications
Agency
Yolo-Solano Air Quality Management
District
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CIRA Members
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City of Alturas
City of Arcata
City of Avalon
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City of Ridgecrest
City of Rio Dell
City of Rohnert Park
City of Sebastopol
City of Sierra Madre
City of Sonoma
City of St. Helena
City of Tehama
City of Trinidad
City of Twentynine Palms
City of Ukiah
City of Upland
City of West Hollywood
City of Wheatland
City of Wildomar
City of Willits
City of Belvedere
City of Blue Lake
City of Calimesa
City of Calistoga
City of Citrus Heights
City of Clearlake
City of Cloverdale
City of Coalinga
City of Cotati
City of Eureka
City of Ferndale
City of Fort Bragg
City of Fortuna
City of Grass Valley
City of Healdsburg
City of Highland
City of Lakeport
City of Menifee
City of Pacific Grove
City of Plymouth
City of Point Arena
City of Rancho Cucamonga
City of Rancho Santa Margarita
City of Yucaipa

CONFIRE
Rancho Cucamonga Fire Protection
District
Town of Truckee
Town of Windsor
Town of Yountville
Town of Yucca Valley
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NCCSIF (Northern CA Cities Self-Insurance Fund)
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City of Anderson
City of Auburn
City of Colusa
City of Corning
City of Dixon
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City of Folsom
City of Galt
City of Gridley
City of Ione
City of Jackson
City of LincolnCity of Elk Grove

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City of Marysville
City of Nevada City
City of Oroville
City of Placerville
City of Red Bluff
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City of Rio Vista
City of Rocklin
City of Willows
City of Yuba City
Town of Paradise

4. Firm Qualifications, Experience and Past Performance Respondent shall provide the following:

1. Based on your firm’s expertise and qualifications, please explain why your firm and/or team is best suited to provide the services requested under this solicitation.

By choosing LWP, the City will not be choosing an “administrator”. You will be choosing a “partner”. We will make it our mission to improve your results. Some of the advantages of partnering with LWP are:

Superior Support for Injured Workers – We have proven repeatedly that providing the proper support for the injured worker can serve to ease the process for the injured worker, prevent unnecessary litigation and significantly reduce the overall cost of each claim. We understand that doing the following serves the best interests of both the injured worker AND the employer. •
•
Thoroughly explain the WC process and benefits
Maintaining open lines of communication, the sharing of active claim information with assigned LWP claim professionals and effectively eliminating potential language/communication barriers via LWP CareConnect.

Expedite Medical treatment and remove the obstacles of UR whenever possible Facilitate temporary and permanent modified duty
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• Resolve all issues swiftly and fairly
Our Unique approach to Account Management – At LWP, we believe that Account Management should be viewed as “management” rather than as a “sales” function. Unlike most in the industry, we do not employ separate Account Managers. Our Claims Managers are our Account Managers. We do this because we believe that this is consistent with our Culture of Accountability.

A client will never hear “they shouldn’t have promised that”, or “I don’t know why they didn’t do that.” There is no “they” at LWP. The managers who make the promises are the same managers who must deliver on those promises.

We ADJUST Future Medical Claims- We do not PROCESS them - It is also common for LWP to identify opportunities for claim closure as well as reductions in treatment for future medical claims upon intake.

When assuming future medical claims, we will review not only the current treatment patterns, but also the award as well as the medical reports on which the future medical award was based. It is not uncommon to find that over time, treatment has evolved beyond the scope of the award, and that bills are being “processed” rather than “adjusted”. LWP can often impact those future medical claims by either reintroducing controls, or even by lump sum settlements, if agreeable to the client.

Businessperson mentality- Judicious Use of Resources - We attract clients who are more focused on results than on price. They are clients who recognize that spending an extra dime to save an extra dollar is a sound business decision. That businessperson mentality is also imbedded in our philosophies and staff training. Our Examiners are trained to treat the clients’ money as if it were their own. At LWP, we

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do not believe that more is necessarily better. We believe that Case Managers, Utilization Review, Legal Services and other services can be very effective in the right situations but tend to run up claims costs and impose unnecessary delays when over utilized. At LWP, we look for ways to confine these services to cases where we believe there is a high likelihood of impact.

Additionally, LWP will not engage others to do work that our own staff can do. We will not engage a vendor in pursuit of savings or recoveries that are likely less than the cost of the vendor’s work. Plainly stated, we will not spend a dollar to try to save fifty cents.

Our culture of accountability - Our goal at LWP is to be a great place for great professionals to work. We have no tolerance for mediocrity and make no attempts to be a nice place for average performers to work. It is our philosophy to always hold ourselves to higher standards than those to which our clients hold us. We measure and monitor performance extensively and have a rigorous performance management system. We use Key Performance Indicator reports, weekly and daily tracking reports and several built-in system monitors to ensure that we meet and exceed performance expectations.

Additionally, we undergo frequent audits by carriers (primary and excess), reinsurers and the State. We dissect every audit to learn what we can do to further strengthen our work product, no matter how positive the auditor may view the results.

Good enough is Never Good Enough - Corny, but very relevant. At LWP, we are never satisfied with our own performance, or with our programs or services. We are ALWAYS looking for a better way. We dissect all client feedback and also continually scour the marketplace looking for new and better techniques by which we can improve client results. We continually seek feedback from our clients so that we can further enhance our service delivery, not only for that particular client, but for all our clients. We are never defensive about feedback.

Proactive Diary Management- We have developed an approach that is both action-based and outcome- focused. We do not wait for weeks to learn whether an appointment or deposition actually happened.

Action diaries are set to find out immediately whether a planned event took place, so that we can ask for an update, and act quickly, often before reports are prepared. And we always begin with the end in mind.

In addition to action diaries, every file has a “case resolution” diary, which is worked at least every 45 days. By taking this approach, we are not only attending to all the various details of handling, but are continually mapping the road to closure, to ensure that all actions are leading us toward a swift resolution.

Litigation Prevention and Management - LWP is very adept at litigation prevention. Our litigation rates are significantly below the state averages. We attribute this to our disciplined adherence to our principle of keeping injured workers informed, letting them know what to expect, and then ensuring that we follow through on all commitments. But when litigation does occur, we manage defense attorneys aggressively and cost-effectively. We NEVER pay attorneys to do work that the Examiners can do. We do not automatically assign cases to counsel when an injured worker becomes represented. We are often able to resolve those cases without the use of a defense attorney. As with most things, some of our clients designate their own panel, while others utilize the LWP panel. Our philosophy is to identify attorneys, rather than firms, and to hold them to the same standards of accountability to which our clients hold us.

Our Results validate our approach - LWP recognizes that the ultimate success of our efforts is not measured by what we do, but by what we accomplish. The objective of all our programs and practices is to contribute to our clients’ profitability by fulfilling their Workers’ Compensation responsibilities as cost effectively as possible.

2. Provide firm’s overall experience, technical competence and qualifications to provide the required services. Highlight firm’s qualifications relative to the minimum qualifications of the RFP.

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Response to RFP – City of Foster City
Founded in 1990, LWP Claims Solutions focuses exclusively on Workers’ Compensation claims management. Aside from a very small presence in Nevada and Arizona, LWP’s focus is California WC claims management. A privately held company, our current client base includes a wide variety of insured as well as self-insured clients, public and private organizations, as well as captive and self-insured groups.

We have achieved a level of diversity in our client base that provides long-term success despite the changes in the market that are inherent in Workers’ Compensation. LWP Claims Solutions is a Corporation wholly owned by Judy Adlam, who actively manages the Company, serving as President and CEO since 1998. Our claims staff works from our claims’ offices in Sacramento, Walnut Creek and Glendale, CA, Las Vegas and Arizona.

We maintain an “operations” office in Sandy, Utah, from which our Utah team performs functions that include bill pay, policy management, client reporting, client banking and fiscal management and internal financial audit. Our CFO, acting as our VP-Operations as well, is domiciled in Utah and manages these operations.

LWP currently employs a staff of 137 throughout our various office locations.

All Officers are active managers who are intimately involved in the day-to-day operations and bring extensive experience to LWP.

At LWP, our mission is to fulfill our promise to our clients. Our promise is:
“LWP promises to work with the utmost integrity and urgency to exceed our clients' risk management objectives. We will move claims proactively and cost-effectively to closure by securing aggressive medical treatment and facilitating return-to-work, thereby enabling our clients to retain productive employees with minimal impact to their businesses.”
Our guiding principles are:
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“Take care of the customer. The customer will take care of you” “Good enough is never good enough”
“When you realize we’ve made a mistake, take immediate steps to correct it” “We are always looking for the new best way to do something” “Doing the right thing, is always the right thing”
“No excuses”
We use various methods to evaluate our fulfillment of our mission. Those methods include:
• Daily, weekly and monthly management reporting to measure our performance regarding cost- effectiveness, claim closure, and operational indicators (i.e. timeliness of mail, compliance with diary standards, prompt and effective 3 point contact, etc.) •
•
Quarterly and semi-annual stewardship reports, customized to each client Claims Vice President and President make regular “chat” calls to clients to solicit feedback

3. Provide number of years firm has been in existence and its ability to provide services through the duration of project period.

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In business for 34 years, LWP is a results-oriented Third Party Claims Administrator with extensive experience in self-insured administration. The Company is properly licensed and in good standing with the State of California.

We have a proven track record for delivering measurable improvements in our clients’ results that are often quite dramatic. The City can expect those improvements to begin during our claims intake process and to continue indefinitely. A few examples of results we have delivered to our clients have included:

4. Describe your firm’s experience in the laws (Labor Code), practices, and procedures relating to Workers Compensation Claims Administration, specifically within a public entity setting (City, County, School District, Special District).

LWP has managed claims in CA continuously since our founding in 1990. We’ve managed claims for public schools sin ce 1994 and for municipalities (including cities and counties) and for special districts since 2013.

We currently manage claims for 101 municipality clients who either purchase services independently or through a pool.

5. Submit three (3) references from public entities for relevant work performed in the last (5) years. If possible, include references from public entities with a similar employee population size as the City.

Respondents reference information shall include:
a. Client’s name, contact person, contact person’s responsibility and relationship to the project, address, telephone number, and email address
We offer the following references for whom we continue to provide services similar to those requested by the City;
City of Fremont
Steve Schwarz
Risk Manager
3300 Capitol Ave.

Fremont, CA 94538
(510) 284-4052
[email protected]
City of San Mateo
Yuliya Shukhat
Sr. Risk Management Analyst
330 West 20th Ave.

San Mateo, CA 94403
(650) 522-7263
[email protected]
City of Burlingame

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Maria Saguisag-Sid
Human Resources Director
501 Primrose Road | Burlingame, CA 94010
Tel. (650) 558-7209 | Fax (650) 340-0331 |
[email protected]
b. A description of the type and extent of the services provided by Respondent, and whether the organization is single, or multi-site.

LWP provides full services bundled workers’ compensation claims management for each of the cities referenced. Each is a California City.
c. A description of the project, the scope and depth of services provided, the project timeline and cost While the City of Burlingame is similar in size to the City of Foster City, should LWP assume responsibility for currently open files, the other references are for larger clients in the range of $225K per year. The scope for each project is very similar to that required by the City. d. Names of key personnel on Respondent’s team that participated in named projects and their specific level of participation, roles, and responsibilities Amber Davis and Stacey Bean work together to both oversee the staff supporting these cities, as well as providing Account Management.

5. Key Personnel and Staff

1. Identify how your staff will be organized and managed to support and deliver services required. Explain why your proposed staff represents the optimal mix of labor resources to complete the work in a timely and efficient manner yielding the best value to the City. Describe the depth of staffing capabilities to provide the required services.

At LWP, we recognize that identifying the right staff for any particular client is part art, part science. LWP takes very seriously the process of matching the proper Examiner with the client. We consider .
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Client culture and objectives
Relevant experience
Examiner’s caseload (both new loss volume and pending)
Feedback from the client
We offer the following staffing model for the City’s consideration.

Proposed Staffing
1 Account Manager – Partially Dedicated
1 Claims Supervisor – Partially Dedicated
1 Sr. Claims Examiners- Partially Dedicated

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1 Future Medical/Medical Only Examiner- partially dedicated 1 Claims Assistant – partially dedicated
Additional support (to include mail room, scanning, check printing, bill payment, trust fund replenishment and balancing and loss reporting) will be provided by our Centralized Services Team)
LWP goes well beyond meeting the statutory requirements for our staff. Our public agency staff is 100% State certified, having all completed the initial required training, as well as a minimum of 24 hours of continuing education each year. Our training efforts do not stop there. Our advancement and promotional policies include a training component as well. No matter how exceptional an Examiner’s performance might be, they cannot be promoted without completing industry designations, including the Self-Insurance Certification.

At LWP, Indemnity Examiners manage no more than 125 claims at any one time, and 200-250 claims per Future Medical/Medical Only Examiner.

Supervisors do not carry caseloads at LWP.

Each supervisor oversees the work of 3-5 Examiners.

We have found tremendous success with this staffing model. We find that if examiners are given enough work to be challenged and fully engaged, but enough time to thoroughly adjust claims they are the most happy and productive.

2. Provide an organization chart and staffing plan identifying key personnel, related lines of authority and responsibility of those team members who will provide the services described in this RFP. Identify any sub-consultants and identify their role.

We have identified Amber Davis as the Account Manager and Transition Manager for the City.

Amber joined LWP in 2003 as a Workers’ Compensa�on Examiner, havingAmber Davis Director of Claims
Public Entities
adjusted workers’ compensa�on claims since January 2000. She is a graduate of Ricks College with Associate in Arts & Science. She holds the California Self Insured Cer�ﬁcate since 2003. She is a Cer�ﬁed Adjuster under the California Insurance Code and the California Code of Regula�ons. Amber was promoted to Claims Supervisor in 2008, Claims Manager in 2013 and Claims Director in 2022. She oversees all staﬀ the support our Northern California public agency clients, and all public pools. Having joined LWP as an Examiner, she has adjusted, supervised and /or managed claims for public schools con�nuously since 2003.

In her role, she will ensure that our programs and protocols meet the City’s needs and are followed. She will ensure the technical adjusting meets the expectations of the City.

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Stacey Bean serves as Assistant Claims Manager, suppor�ng Amber’s teams. Stacey works closely with Amber Davis, our clients and with the claims teams to provide support to our Northern California public agency clients, and all public pools.

Stacey joined LWP in 2012 as a Workers’ Compensation Examiner. She hadStacey Bean previously worked as the Workers’ Compensation Specialist for a Self-Insured employer in California for 11 ½ years. Stacey was promoted to Supervisor in 2017 and became an Assistant Manager in 2022. She earned Bachelors in Organizational Management Degree with distinction from Ashford University.

She has held the California Self Insured Certificate since 2011. She is a Certified Adjuster under the California Insurance Code and the California Code of Regulations and holds other certificates related to Workers’ Compensation.

Stacey works closely with Amber Davis, our clients and with the claims teams to provide support to our Northern California public agency clients, and all public pools.

Assistant Manager
Jointly, they will ensure that our programs and protocols meet the City’s needs and are followed. They will attend all claim reviews, City meetings, will present cases to the City Council, if that is of interest, and will provide training and stewardship to the City’s staff. Amber Davis has unlimited authority to resolve issues on LWP’s behalf.

We have not yet identified supervisor or examiner candidates for the City to consider. Upon contract award, we will develop a list of candidates and would be happy to make them available for the City to interview. Neither managers or supervisors ever carry at caseload at LWP.

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Judy Adlam
President & CEO
Brian Esparza
VP Claims
Operations VP / CFO
Staff of 10
Claims Quality Assurance
Team
Amber Davis - Director of Claims
Sacamento CA
4 Claim Supervisors
5 Support Staff
Stacey Bean
Assistant Claims Manager
Supervisor
City of Foster City
Partially Dedicated Sr Examiner
Senior Examiner
MO/FM Examiner
Paritally Dedicated
Senior Examiner
Claims Assistant
Partially Dediated
5 Units Plus Support Staff
Claims Manager
Glendale CA
Claims Manager
Sacramento CA
Claims Manager
Sacramento CA
2 units plus
support staff
2 units plus
support staff
2 units plus
support staff

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Response to RFP – City of Foster City
Subcontractors: LWP’s business philosophy is to limit the work we do ourselves to those things that we are confident we can be the very best at. For that reason, LWP’s employees perform claims administration functions and extensive oversight of managed care and ancillary services.

For managed care and ancillary services, our approach has been to build partnerships with “Best in Class” partners and to then build our own capabilities and tools to enhance their services and ensure the ultimate effectiveness of the partnership by building extensive oversight and integration procedures and tools. Our integrated services are offered through “SPHERE Solutions”, our trade named division.

We have several LWP staff members with very significant experience overseeing our Managed Care programs, adding an extensive layer of auditing and quality control to both our programs (Bill Review, Utilization Review, Case Management, PBM and other programs) as well as to the billing and results reporting.

Our Recommended Partners should the City choose to review them are; Signature
Networks Plus
Genex
Managed Careaccuro Optum One Call HomeLink
Proprietary MPN
Bill Review
Utilization Review
Case Management
Signature Networks Plus
accūrō Solutions
Genex
Genex
Signature Networks PLUS - Signature is a Cypress, California based organization whose focus is in workers’ compensation insurance services. They maintain 3 locations, corporate office in Cypress, California and field offices in Granger, Utah and St. Louis, Missouri. To date they have developed and currently manage approximately 100 Medical Provider Networks (MPNs). They offer the flexibility to build to our clients’ specific needs and also offer custom Outcomes Based network programs. Signature developed and manages LWP’s proprietary Medical Provider Network, and will serve as network manager, should the District decide to utilize LWP’s network. accūrō Solutions – a sophisticated provider in the workers compensation claims space, delivers customized solutions with the determination to modernize the Medical Bill Review industry. Through their ARC (Automation, Reliability & Collaboration) System, built on a foundation of modern technologies, accūrō Solutions provides unprecedented flexibility, scalability, and reliability to their clients. accūrō Solutions provides LWP with bill review software, and aggregate payment models to serve LWP’s clientele efficiently and with care.

Genex- serves as LWP’s Utilization Review and Nurse Case Management Partner, since purchasing Excel Managed Care, our partner since 2009.

Genex has 2,000+ direct-employed case managers, including more than 1,025 catastrophic case managers. In addition, they have over 265 bilingual case managers, with more than 50 in California alone.

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Genex improves RTW outcomes by more than 35%, compared to national benchmarks established by WCRI. For cases managed by Genex, 79% return to work within 30 days of referral.

Genex has 150 employees in the Utilization Review Department and uses a combination of both employed and contracted nurses and physician advisors. They directly employ three (3) medical physicians, 48 chiropractic physicians, and 15 registered nurses whose tenure with Genex averages 12 years. They contract with over 600 physicians, nurse practitioners, and registered nurses to service our customers’ clinical requirements. 95% of their contracted physicians are practicing physicians. They believe using physician reviewers who are in active practice leads to more informed, quality decisions.

Genex UR services are managed under the direction of their clinical medical director, Dr. Dan Maldonado.

In addition to these services, LWP has built a Medical Savings program, through which we offer access to specialty services and networks that are available to the District.

Pharmacy Benefit Network-
Durable Medical Goods-
Translation and Transportation-
Expedited Diagnostic Testing
Physical Therapy Network-
Optum
One Call Medical and HomeLink
One Call Medical and HomeLink
One Call Medical and Homelink
One Call Medical and Homelink
Optum – Optum came to be LWP’s partner through a series of mergers. Established in 1976, Progressive Medical merged with PMSI and rebranded their company as “Helios”, which then merged into Optum.

Enjoying a long-term partnership with Progressive Medical, our management and day-to-day contacts have remained unchanged despite these mergers, giving LWP the advantage of more advanced technology coupled with partners who understand LWP’s programs, philosophies and our clients’ needs.

As a full-service provider of technology-enabled, clinically driven services for Pharmacy, DME, Home Health Care, Transportation, Translation and Settlement Solutions, they deliver innovative solutions for cost containment across the claims lifecycle. The Optum companies have served as trusted resources for thousands of insurance payors, state workers’ compensation funds, employers, and third-party administrators for nearly 40 years. Today, Optum continues its leadership position by managing millions of pharmacy, DME, home health, transportation, translation, and settlement transactions for our clients each year. LWP partners with Optum for Pharmacy Benefit Network and physician peer-to-peer services.

One Call – An industry leading managed care provider, One Call has built best I class services through acquisition and innovation. For Physical Therapy, they purchase Align Networks, who had created a program that is “comprehensive yet simple.” Unlike generalist networks, Align Networks developed specialized protocols for their network providers. Instead of focusing on back-end discounts, they actively manage cases up front, focusing on communication and the best patient care to ensure the fastest return-to-work results, resulting in quicker turn around, lower costs, and increased quality care. For Transportation, One Call developed Relay Ride, an industry leading program that utilizes their proprietary software to manage the utilization of Lyft on-call transportation, offering very significant savings.

HOMELINK - Began as an idea within an HME buying group for community-based providers. An idea in the mind of a visionary with a simple philosophy: coordinate outstanding home health care services for people to recover and experience a higher quality of life. HOMELINK’s 500+ employee owners connect

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over 1,200 payers. These payers are connected to more than 36,000 core providers and an additional 72,000 community-based providers in our database, giving the highest quality of care to more than 30 million covered lives. Today HOMELINK has expanded its service offerings to everything under the ancillary umbrella including durable medical equipment, orthotics and prosthetics. home and vehicle modifications, transportation, translation, hearing healthcare, diagnostic imaging, outpatient physical therapy, post-acute care, and more. HOMELINK is relentlessly committed to providing unparalleled customer service and unsurpassed value to its loyal customers.

All fees will be billed through Sphere Solutions, our managed care arm. Fees are included in the pricing proposal.

3. Identify the personnel that will be assigned to the City’s account. Include a statement of qualifications, including specific information outlining experience in handling self-insured public entity claims. Claims Adjusters assigned to the City’s account must have the equivalent of five (5) years’ experience adjusting workers’ compensation claims and possess a Self-Insured Plan (SIP) Certificate. The Supervisor must have a minimum of five (5) years’ experience handling and supervising workers’ compensation claims and possess a SIP Certificate.

It would be disingenuous to suggest that hiring and retaining talented future employees is an easy task.

It is, in fact, the most difficult challenge we face. While there is always a stream of candidates in the marketplace, the pool of high-quality prospects is much more limited. And every TPA and Insurance Carrier is looking for good people.

We have iden�ﬁed Amber Davis as the Account Manager/Claims Director Amber is our much-in-demand manager who oversees the teams who support our Northern CA public agency claims. She has held progressive posi�ons with LWP since 2003.

Stacey Bean serves as Assistant Claims Manager, suppor�ng all Amber’s teams. Stacey works closely with Amber Davis, our clients and with the claims teams to provide support to our Northern California public agency clients, and all public pools.

We further oﬀer Amber Davis as the Implementa�on/Transi�on Manager. Amber has served as transi�on manager for all our intakes since 2010 and will ensure a very seamless implementa�on/transi�on for the City.

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Stacey joined LWP in 2012 as a Workers’ Compensation Examiner. She had previously worked as the Workers’ Compensation Specialist for a Self-Insured employer in California for 11 ½ years. Stacey was promoted to Supervisor in 2017 and became an Assistant Manager in 2022. She earned Bachelors in Organizational Management Degree with distinction from Ashford University.

Stacey works closely with Amber Davis, our clients and with the claims teams to provide support to our Northern California public agency clients, and all public pools.

Stacey Bean
Assistant Manager
LWP had not yet identified the Claims Supervisor for the City to consider. Upon contract award, we will make one or more candidates available for the City to consider.

Claims Examiners have not yet been identified to support the City. Upon contract award, we will identify candidates for the City to consider. The criteria used will be:
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.
.
.
.
.

Minimum of 5 years Adjusting Experience
2 years’ Experience managing claims for public entities (including 4850 ) Licensed Self-Insured Administrator
State Certified Examiner Status
Receptivity to the City’s program needs
Must be able to meet LWP’s stringent performance standards (exceptional communications, time management and critical thinking skills required)
Candidate must also successfully pass LWP’s background checks (credit and criminal).

4. Provide appropriate resumes only for key personnel (including subconsultants) that will be assigned to this project. Resumes shall highlight title, education, licenses and certifications (issue and expiration

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dates) with similar project experience and qualifications for the services described in this RFP. Resumes should be limited to no more than two pages each.

We have provided Bios of our management and key staff in order to give the City a feel for the qualifications of LWP. Bios for leaders of our subcontracting services are included as Addendum D.

6. Technical Approach and Methodology

1. Based on your firm’s similar past experience provide a description of the anticipated procedures and general approach that will be used to perform the requested services. Discuss objectives, recommendations and solutions. Respondent is encouraged to identify and recommend any improvements/enhancements for the proposed service, as well as highlight other issues Respondent deems prudent.

LWP is prepared to hit the ground running. We are confident that we can control the City of Foster City’s Workers’ Compensation costs while easing the process at the same time. We recognize that you are seeking a partner with a good understanding of the principles that differentiate excellence in Workers’ Compensation from mediocrity and require a partner who can deliver. LWP is that partner! Our exclusive focus on Workers’ Compensation claims coupled with our results-oriented culture allow us to balance the need for customization with the discipline to execute our Best Practices and deliver superior results. We are confident that we can deliver services that will provide you with a distinct financial advantage. In addition to providing initial programs that are tailored to the City’s needs, LWP is committed to providing access to new programs and strategies that are developed to meet the ever- changing Workers’ Compensation environment. Based on our understanding of the program, we believe that the ability of a new TPA to succeed will boil down primarily to the following:
•
•
Staffing the team properly
Installing the Programs: (including the Clinical Component, Medical Provider Network, Disability Management, Litigation Support, Subrogation Support, and Special Investigations) Managing the IT Component
Assimilating the Claims and Providing Transition Support Disciplined Execution of Best Practices
•
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•
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Effective Cost Containment Strategies
Client Support
Because our service model is based on the principle of customizing our services to meet the unique characteristics and needs of our clients, we offer a menu of possible services. We expect to further refine our recommendations and customize and tailor our services by working with you to identify particular areas of need.

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Staffing the Team Properly
Recognizing that the success of the program hinges on providing the right staff, both in numbers and in qualifications and performance, we have offered our staffing plan above. We will present fully quaililfied candidates to the City for your consideration, and will factor your feedback into our management of the team at every step.

Installing the Programs
Immediately upon selection of LWP, we recommend a meeting with City of Foster City and LWP to ensure that all claim management programs are properly tailored to meet your specific needs. We are confident that our processes will support those programs that are working well, and through collaboration we can strengthen results in other areas. We believe in continually refining our approach to stay ahead of the ever-changing external legislative, judicial and clinical factors that can drive costs up. Our initial recommendations on an approach to the major claims programs are:

The Clinical Component
At LWP, we believe that excellence in clinical management is the best way to shorten disability durations and speed both return-to-work and claims closure. Our track record for excellent outcomes is the result of our focus on aggressive up-front medical treatment, a reliance on evidence-based protocols and very aggressive return-to-work efforts. We subscribe to the sports medicine philosophy of medical treatment.

We advocate immediate diagnostics and early aggressive treatment to shorten the treatment timetables and keep the injured worker focused on recovery and return to work. Additionally, we know that passive treatment and delays can also lead to dependence on pain medications and the resulting “disability” syndrome. We are willing to “think outside the box” when treatment alternatives are presented that have a likelihood of a productive return to work.

Upon contract award, we will want to schedule a meeting with the City of Foster City to accomplish the following:
• Gain a full understanding of your network preferences (including discussing your perspective about MPN as well as identifying any providers with whom the City has concerns) Agree on UR protocols (which we view as related to the network choice) Determine the City of Foster City’s Preferred providers for Pharmacy Benefits, Diagnostic, Transportation, Translation, Durable Medical Goods (LWP has programs available for all, if there is interest)
•
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Some of our differentiators include:
• UR plan that accommodates adjusters approving needed treatments without delay – roughly 93% of all treatment requests are approved by the Examiner without the delay and expense of Utilization Review
•
•
•
Diagnostic testing program that gives us access to preferential testing appointments at various providers at discounted rates
Two-pronged approach to preventing prescription drug overutilization (including Pharmacy Benefit Network that includes first-fill, and physician peer-to-peer wean down support) Very judicious use of Nurse Case Managers with many assignments limited to one-time tasks Medical Provider Network

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LWP offers a proprietary Medical Provider network that is available to the City of Foster City, if there is interest. We strongly recommend this network as an important tool in litigation prevention as well as a method to contain medical costs.

Our network, developed by Signature Networks Plus, offers clients a very distinct advantage, both in quality of care and in cost. The network is offered in two forms- one including Kaiser and one excluding Kaiser, with all other features of the networks being identical. Some advantages to our network include:
•
•
Statewide Network developed by industry leading network developers Providers were carefully chosen based on extensive data that measures outcomes (return-to- work and treatment durations)
• Need for utilization review is significantly reduced by the quality of physicians (saving time and expense)
•
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Significantly deeper discounts than most MPNs
No access fee (client pays only the PPO % of savings BELOW fee schedule without any separate access fee.)
• Litigation rates are reduced through use of a good network Upon contract award, we hope to meet with you to better understand your perspective toward Medical Provider Networks and any interest you may have.

Disability Management
LWP is committed to proactive disability management that is focused on early and sustained Return-to- Work. We recognize the need for early aggressive medical treatment so as to minimize disability and facilitate case resolution. We know that claims resolve quicker when the injured worker is returned to work. While an injured worker is disabled, we contact the treating physicians no less frequently than every two weeks. During the call, we attempt to coordinate release to full duty or, failing that, a return to modified or alternate work. Our staff is trained to probe for information about what an employee is physically ABLE to do, rather than accepting “unable to return to work” as a status. We focus on activities of daily living to determine whether we can work with the employer to create modified duties based on those abilities.

Upon contract award, we would like to meet with you to fully understand the City of Foster City’s Return- to-Work Program so that we can most effectively interface. Although we have extensive experience with various Return-to-Work programs, we recognize that each program is designed slightly differently, and want to ensure we design our workflows to interface seamlessly with the City of Foster City.

Litigation Support
LWP believes in aggressive litigation management focused first on avoiding the process and then limiting the use of counsel to task assignments when appropriate. As a result, our clients enjoy litigation rates that are more than 50% below the state average. We believe, and have proven, that prompt and appropriate file handling reduces the number of claims that go into litigation. By involving the injured worker and employer as key members of the claim management team, conflicts and disputes are avoided and/or minimized.

Our litigation management strategies include:
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Referrals to counsel are limited, and when needed, are issue-specific Litigation budgets are required of counsel

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•
•
•
•
All case activity requires the examiner’s approval
LWP examiners maintain control of the file at every step of the process LWP examiners are trained to manage basic legal issues without attorney involvement LWP recommends litigation claim reviews to review all litigated cases with the attorney(s), client and claims staff.

Through these practices we have been able to successfully control our clients’ allocated loss adjustment expenses and the impact that litigation has on average claim duration. When litigation commences, we evaluate the case for resolution at every step of the process. Upon contract award, we will work with City of Foster City to fine tune our litigation management program to fit your EXACT needs.

Subrogation Support
Upon contract award, LWP will discuss subrogation in depth to learn more about the City of Foster City’s philosophies relative to subrogation, particularly relative to your Residents . Our approach to subrogation is to ensure we fully understand the relationships and expectations before we receive the claims. It is our philosophy to aggressively pursue subrogation when appropriate without interfering with any client relationships. Once we have a clear understanding of the expectations, we will customize our protocols and training to support you.

Special Investigations Unit (SIU)
Our approach to SIU is consistent with our approach in all other areas. We do not paint all injured workers with a broad brush. We strive for balance, knowing that fraud must be taken very seriously, yet also recognizing that unfounded accusations and mistrust lead to unnecessary litigation and expense.

In the absence of a specific recommendation from our client, we work with the Dayta Group as our Investigation/SIU partner. The founder and President of Dayta Group has been LWP’s SIU partner since 2004, creating two different teams to proactively fight fraud and create positive claim outcomes. Dayta Group provides LWP with both a compliant and committed Special Investigation Unit (SIU). They provide annual anti-fraud training as well as reviewing suspicious claims upon request. In addition to our joint successes that include 32 convictions and $1.2 Mil in restitution, Dayta and LWP are focusing on prevention, rather than embracing the traditional model of “wait for the lie”, pay, pay, pay and hope to someday get the attention of a District Attorney. We are hoping to send the message to injured workers “Don’t do it here!”
The Dayta Group has leading edge ideas and technology to assist in combatting fraud and minimizing exposure for the City. Dayta Group focuses on fraud prevention and claim mitigation as evidenced by their groundbreaking solutions including VeriFive, iConfirm, and MedELink. They are woman-owned, California headquartered, fraud certified, licensed continuing education program providers, and SIU regulatory compliance experts. Dayta Group thrives on innovation, have technical claim expertise, are passionate about data, are relentlessly client focused, ensure operational excellence, and deliver LWP exceptional partnership execution.

Some of their differentiators are:
• Early, proactive investigations focused on approaching employees early on in order to prevent fraud, rather than waiting, waiting, waiting.
• On-demand presentations to medical providers that leverage new technologies and AI to make the investigation review as simple as possible for the medical provider

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• Network of investigators available based on client preference and Dayta’s detailed due diligence Managing the IT Component
The IT component of this program is very manageable, and we are committed to making a smooth transition. We will want to meet with the City of Foster City immediately upon contract award to develop a step-by-step transition plan for the various IT components of this project. Based on our current understanding, we would expect the following to be required:
• Data conversion and document intake from the City of Foster City’s TPA’s current claims system (including claims, documents and Bill Review history)
•
•
•
Access to our claim system
Set up regular data extracts and reports to meet the City’s needs Any required performance data, metrics and stewardship reports Assimilating the Claims and Providing Transition Support Should the City determine that prior claims will be handled by LWP we are very prepared for this transition. LWP has extensive experience in assimilating claims that have been previously handled by other administrators. We understand that claims handlers can make a very significant impact on the bottom-line results of a book of business. Although it is always ideal to manage a claim from day one, we do recognize that it is very possible to impact outcomes, even long after the claim arises. Our staff is trained to look for missed opportunities to impact outcomes, and to focus on accurate reserving, coding and outcome-based adjusting. We have a track record for focusing quickly on the right things, including:
•
•
•
•
Identifying any claims that can still have major course corrections and produce savings Accurately coding claims to allow trending of litigation, subrogation, etc.

Quickly identifying and pursuing subrogation/contribution opportunities before statutes run Systematically evaluating all claims for closure and cost-effectively closing down exposures We understand that the challenge of implementing the new program cannot distract us from also closing down those older files that can be resolved in the near term. We are very experienced at doing both things simultaneously. Some recent successes have included reducing the pending claims of a Joint Powers District from 374 indemnity claims (received from their prior TPA upon transfer) to 302 within 18 months and now to less than 290 claims.

Our experience with managing takeover files enables us to commit to the following:
• Within 30 business days of claim data intake, all claims will be on diary and all disability calls will have been made
•
•
Within 45 days all initial plans of action will be updated Within 60 days, we’ll be prepared to meet with the City of Foster City to review all open claims to discuss any issues identified, followed by transition to an ongoing claim review schedule. • At 70 days, we’ll be prepared to meet with Defense Counsel to conduct a litigation review.

Upon contract award, we will meet with the client to finalize the transition plan, should current claims be transferred to LWP, and then will provide weekly updates until the transition is complete.

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Disciplined Execution of Best Practices
LWP has a proven track record for disciplined execution. We have documented those practices that we are confident facilitate achievement of outstanding results. Upon contract award, we work with our clients to compare our best practices with those of the client. In all cases, we will hold ourselves to the higher of the two standards in each performance area.

We measure and monitor our examiners’ performance to be sure that the agreed Best Practices are utilized. We know that the difference between excellence and mediocrity is in the blocking and tackling that occurs each and every day. Yet, we also recognize that even tried and true techniques are not always the best course for any particular claim. Our Examiners are empowered to evaluate the circumstances of a claim and to consider an alternate course of action that is likely to lead to a better result for a particular claim. We want our examiners to “do the right thing,” rather than merely “doing things right.” If at any time, the Examiner proposes an alternative strategy, this will be discussed with the client prior to embarking on an alternative path.

At LWP, we recognize that our core responsibility is to investigate, adjust and settle claims.

LWP has extensive protocols to ensure that we determine eligibility for, and then process both medical and indemnity benefits in a timely manner.

Included in our core responsibility is timely payment of benefits and notices to employees. Through careful hiring and training practices working hand-in-hand with a claims system specifically designed to move claims toward conclusion while complying with all regulations we are able to effectively meet this responsibility. Our unique approach to supervision and management also ensure compliance with the California Labor Code.

Integral to our approach to claims handling is client involvement. The City will maintain final control of each item requested. Communications will be established to ensure that you are always aware of claim status and approval is sought when appropriate.

Once the objectives of the program are clearly defined and the City -specific work flows and Best Practices have been created, LWP will manage the claims according to those handling guidelines. We anticipate the life of an indemnity claim to be represented by the graph below; Indemnity Claim Timeline

FIRST CASE

RESOLUTION
DIARY

CLAIM REPORTED
TO LWP
3 POINT CONTACT
MADE

PLAN OF ACTION

CREATED

SUPERVISOR
REVIEW
Day 1 Day 1 24 hours Day 5 Day 14 Day 28 Day 30 Every 45 Days Day 90 Every 90 Days

SUPERVISOR

REVIEWS AND

ASSIGNS CLAIM

INITIAL RESERVES
SET

SUPERVISOR
REVIEW

PLAN OF ACTION

REVIEWED

SUPERVISOR
REVIEW
LWP will set up a claim and begin the three-point contact process immediately upon receipt of ANY notice of a claim. LWP Examiners are required to make three-point contact on all Indemnity claims within 24

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hours of receipt, with the first contact always being the employer. If voice-to-voice contact is not achieved, the Examiner will continue efforts to reach the parties until accomplished.

Once the three-point contact in completed the claim begins a cycle of processing that is continually focused towards closure.

LWP’s contact is focused on determining what activities the employee is ABLE to perform. We do not accept “unable to work” as a status. We look for the activities that CAN be performed, including activities of daily living. We then work with the employer to determine whether temporary modified work can be available to keep the employee at work.

Our supervisors review reserves each time they touch a file. After assigning the claim and providing initial direction to the Examiner, they first see the reserves at their 28 day review, and then subsequently at each touch point and on each oversight diary. Supervisors maintain oversight diaries no longer than 90 days apart, and more frequently for files with significant issues. Additionally, they must approve all reserve changes that meet the client thresholds as well as reviewing the reserves in preparation for each client claim review. Beginning with this review and continually through the life of the claims the supervisor and adjuster will work at each touch of the claim to move toward closure.

Our protocols include regular plan of action updates. For each claim issue, the Examiner will enter a status update as well as a Plan for the Steps necessary to resolve that issue. The scheduled review and update of this plan will allow the City to immediately review the status of the claim at any time through online access.

Continued review by the examiner and the supervisor is maintained using our diary system. Each time a diary is worked another will be set. We consider resolution of the claim at each touch and are constantly working to return the injured worker to work and close the claim. Our Claims and Litigation Best Practices are included as Addenda A and B.

Effective Cost Containment Strategies
Independent of the decision to choose a particular vendor/partner for cost containment services, we know that the results are impacted by the utilization strategy much more heavily than they are impacted by the choice of partner. The question to ask is “When UR should be used?” rather than “Who should provide my UR?” Therefore, we offer our cost containment strategies for the City of Foster City’s

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consideration, so that you can understand our perspective towards utilization. Our programs will all be available to the City, although we understand that you are not currently seeking to utilize the services of a new TPA.

LWP has a proven track record for “doing the right thing”, rather than merely “doing things right”. Our focus is always on the successful outcome, rather than on the savings that can be generated by a single short-sighted transaction.

We maintain extensive cost-containment programs that are designed to first provide access to the best care available, and secondly, to offer cost savings where available. We review our claims and cost containment results regularly to look for patterns that may allow us to fine tune our Best Practices in order to maximize the impact that cost-containment techniques have in the right situations while minimizing the costs and time that can be spent chasing savings that can be less than the cost of the process. Plainly stated, we will not spend a dollar to try to save fifty cents.

LWP’s cost containment program, branded as “SPHERE Solutions,” is flexible and can be adapted to meet the unique needs of the client. We offer a menu of services, as well as interfacing with providers chosen directly by the client. Each service can be customized for each client.

Utilization Review
One of the distinguishing features of LWP’s UR program is our judicious use of UR. As with all other things, LWP does not believe that more is necessarily better. In fact, unnecessary UR can serve to alienate treating physicians and injured workers and drive up employers’ costs. We continually monitor each Examiner’s utilization to look for training opportunities. Examiners are encouraged to approve diagnostics and treatment that are very unlikely to be denied or modified. This can even include approving surgeries based on positive objective diagnostic findings. This approach is also consistent with our sports medicine philosophy to ensure aggressive, up-front medical care in order to speed the process from diagnosis to recovery.

Nurse Case Management
It is our philosophy to utilize nurse case management on a case-by-case basis. We believe that Case Managers can be an invaluable resource in the right situations. But indiscriminate use drives up claim costs while also diluting the nurse’s effectiveness on the right cases. More is not necessarily better.

Field case management is generally reserved for those claims that are more severe or where face-to- face intervention with both the employee and treating doctor will serve to facilitate an early return to work and recovery. Most field case management assignments are task-specific, with the field case manager assigned to attend a medical appointment or meet with an injured worker and their family, after which they close their assignment until/unless requested to take any additional action.

We recommend case management services be implemented when a need is identified and should end when they are no longer impacting the return to work efforts or ultimate claim outcome. The specific guidelines are tailored to each client to be consistent with their return to work program.

Medical Bill Review
At LWP, we believe that the most important component of bill review is identifying the best network for a client. Our clients can access both national and customized networks, and networks can be stacked in order to maximize savings. In order to provide extensive flexibility, we have built an internal system that adds a significant layer of quality control that sits on top of a bill review company’s software. By using this

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approach, we are able to offer our clients a full assortment of network options while still ensuring accuracy of reviews and payments and consistency across networks and providers. We have a fully integrated interface with accūrō.

Medical Provider Network
LWP offers our client’s access to a proprietary Medical Provider network that we believe offers a very distinct advantage, both in quality of care and in cost. The network is offered in two forms- one including Kaiser and one excluding Kaiser, with all other features of the networks being identical. Some advantages to our network include:
•
•
Network developed by industry leading network developers Providers were carefully chosen based on extensive data that measures outcomes (return-to- work and treatment durations)
• Need for utilization review is significantly reduced by the quality of physicians (saving time and expense)
•
•
•
Significantly deeper discounts than most MPNs
No access fee (client pays only the per-bill bill review fee, which includes MPN access) Simplified enrollment
Should the City choose to utilize LWP’s network, there is no filing to do. LWP will provide the documents for posting, and the MPN can be utilized on Day 1.

Should the City prefer not to use a network, or prefer to choose another network, LWP’s bill review partner can access any network that the City of Foster City makes available.

Prescription Drug Management
LWP has implemented an aggressive, multi-pronged approach to controlling Pharmacy Costs. Our program includes the following:

Pharmacy Benefit Network (PBN) – LWP has a strategic partnership with Optum for pharmacy services.

Optum’s extensive network and pharmacy cards provide accessibility and ease of use for the injured employees. The network pricing and utilization review allows LWP to monitor medical use and control claim costs for our clients. Features include:
•
•
•
•
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No prescriptions can be filled in physicians’ offices
First Fill cards provided to employer
Home Delivery service available
Brand to generic channeling
Both network discounts and out-of-network retrospective reviews Robust database checks for drug interactions, non-formulary prescriptions, over-utilization and prescriptions filed by multiple physicians
Peer-to-Peer Physician Intervention- LWP has partnered with Optum to offer peer-to-peer physician coaching for treating physicians who are uncomfortable with the wean-down and detox process. They focus on educating physicians on safe methods of weaning, utilizing drug replacement strategies and detox methods.

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Expedited Diagnostic Testing
For diagnostic services, LWP currently has a strategic partnership with One Call Medical and with HomeLink. The benefits of this arrangement are twofold - (1) preferential expedited appointments to speed diagnosis and treatment and (2) reduced fees for these services. Most tests can be scheduled within 24 hours to avoid the protracted delays that interfere with return-to-work and healing. There is no separate pricing for this program. Charges will be no higher than fee schedule, without any additional administrative charge.

Upon receipt of referral, our partner will contact the injured employee to schedule the diagnostic test at a network facility. Reports are sent to the claims examiner immediately following the diagnostic test.

Durable Medical Goods
LWP has strategic partnerships with One Call Medical and with HomeLink for Durable Medical Goods. We channel to these providers in order to effectively track utilization as well as accessing discounted prices for durable goods (each has its own strengths).

Transportation and Translation Program/Network
LWP has a strategic partnership with One Call Medical. Their Relay-Ride program has resulted in very substantial savings by using an on-demand Lyft transportation model. Their proprietary software allows them to schedule and communicate with drivers and injured workers in real time, offering the injured employee seamless services at a much-reduced cost.

Translation services include the availability of language-line telephone translation in all languages, as well as on-site face-to-face translators for meetings, depositions, and medical appointments.

Physical Therapy
LWP has formed a strategic partnership with One Call Medical and with HomeLink to offer access to their Physical Therapy Network. The benefits of utilizing a network are:
• Removes the financial incentive for physicians to over-prescribe, since the therapy will be performed at a facility in which the physician has no financial interest Consistency of reporting
Discounted fees (8% below fee schedule for Concentra providers, and 16% below fee schedule for all others.)
•
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Clinic Oversight Program
LWP’s managers work directly with medical clinics to improve their reporting practices when needed. We visit the business managers at those clinics to reinforce the necessity of providing timely and comprehensive reports that address our very specific requirements, including our requirement to comment on allowable activities of daily living when reporting any work restrictions. LWP has experienced improved reporting from some clinics following their understanding that patients will be directed to other clinics if we cannot obtain the information needed in order to support our clients.

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Client Support
Proactive service coupled with responsiveness to clients’ needs is the hallmark of LWP’s service model.

We understand that excellent adjusting is at the foundation of all service, yet also recognize that different stakeholders can have distinct needs. Although a larger department may have more claims than a smaller one, each and every department will enjoy customized service to meet their specific needs.

We expect to have very frequent communications with the City of Foster City’s Risk Management team and staff. We feel that it is very important to involve our clients in both routine and high-level issues to ensure the maximum level of claims management is being provided. Successful claim outcomes can be traced very specifically to teamwork between the employer and the administrator.

We communicate with our clients through a combination of email, telephone and face-to-face means.

You and your staff will have cell phone numbers for the Claims Supervisor, the Claims Director, Vice President of Claims and the President/CEO. All will be available to assist with issues, large and small.

Additionally, we expect to provide regular reports that detail the status of various issues. You can expect regular calls from our management and meetings at whatever frequency is preferable to you.

2. If applicable, describe your firm’s approach for a transition plan from the current provider. Include information on the time needed for the transition, key concerns, issues, and recommendations for a successful transition.

In the past 18 months we have successfully completed 6 takeovers and 1 loss portfolio transfer that involved claim, notes, documents and financial records.

We begin the process by accepting a test file of data from the incumbent TPA in any format they wish to provide. We import that data into a staging environment where we:
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map the prior TPA's data to the corresponding fields in our claims systems (Origami Risk). evaluate their prior organizational structure and work with our new client to make any desired changes,
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set up the primary and excess policy structures in Origami, and evaluate the financial data to understand the previous TPA’s handling and coding practices -- we take into account reserving practices, their coding of recoveries, and excess. We continue to evaluate the data until we can balance to the penny!
We then do test intakes into Origami during which we balance the Origami data to independent loss runs from the prior TPA and ensure the available statistical data is in Origami.

While this is going on we work with the new client to set up, if required, any changes to bill review or pharmacy programs and to implement any custom reporting that is desired. We arrange the transfer of any legacy claim files that are in storage. We work to notify the claimants of the TPA change and arrange to handle new claims and indemnity payments that occur during the transition. We set up access accounts for our new client and work out the details of how claims are reported. We have at least weekly transition calls with client and the previous TPA to manage this entire process.

By the time the actual transition occurs we are prepped and ready to swiftly intake the data as soon as the prior TPA provides it.

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After the transition, we ensure that the required jurisdictional and CMS reporting is set up and working smoothly.

Upon contract award, we will meet with the City to finalize the transition plan, and then will provide weekly updates until the transition is complete.

3. Provide a sample TPA monthly report.

LWP maintains very robust reporting capabilities. We deliver reports via several methods:
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Regularly scheduled reports are emailed to clients
Client access to run reports using multiple templates
Client access to ad hoc reporting
Customized reports prepared by LWP staff
Stewardship reports
Scheduled Reports - Upon contract award, LWP will meet with the City to determine the reports that you would like to receive on a regular basis. These reports will be delivered to you on your specified schedule.

The menu of reports available includes:
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Cumulative Loss Runs (can be provided at any organizational level) Fiscal Period Report (including detailed financial transactions, reserves, payments and recoveries) during a stated period of time. It can be run with detail, or summarized Closed Claim Log
Claims logs of various claim identifiers (ie. First Aid, Litigation, Back Claims, etc.) Standard Claims Summary (financial and data summary of each claim) Payment type reports
Loss Triangle Reports (incurred, paid, outstanding)
4850 Reports
Injury Type Reports (Cause, Site, Nature of Injury, Occupation) Lag Time Reporting (date of loss/date report)
Losses reported by tenure with Company
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OSHA 300 and 300A
Check Registers
Individual Claim Reports (Notes, reserve activity, plan of action, etc.)

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Standard reports templates allow user to specify:
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Filters (i.e. open vs. closed, claim type, date opened, date closed, etc.) Organizational and timeframes - (i.e. reports can be run by division and/or department, and for any fiscal period)
. “Value as of” capability
Ad-Hoc Reporting: The City can also have access to Origami’s Ad Hoc reporting tool, which allows for real ad hoc creation of spreadsheets containing any of more than 100 data elements. Spreadsheets can be sorted, formatted and manipulated to allow maximum access to their data. Data from the prior administrator will be made available through this tool (subject to the quality and availability of that data).

All reports are exported to Excel spreadsheets. Reports can be stored and edited for re-use. All data in the report can be as of a user specified value-as-of date or current to that instant in time.

Customized reports prepared by LWP staff: LWP maintains staff with expertise in creating customized reports. The City has unlimited access to our staff and can request ad-hoc or customized reports at any time. We employ a full-time analyst with very advanced capabilities in order to assist clients with advanced reporting and analysis needs.

Stewardship Report: LWP offers both standardized and customized stewardship reporting in both data and graphical format.

All reports are included in the admin fee. Sample reports at attached as Addendum C. At time of contract awards, we will review all available reports to identify those that are of interest to the City.

Additionally, we are happy to review reports that the City currently receives. If the City wishes to receive a report that mimics a current report you utilize, LWP will build that report at no charge to the City.

7. Cost Proposal Cost Proposal Based on your understanding and recommendations, Respondent shall submit a fixed-price cost proposal reflecting a bottom-line price to deliver all the services requested under this solicitation for the three-year duration of the Agreement. The fixed costs shall be inclusive of all costs and materials for preparing the scope of service. No payment will be made for any other expense or cost.

Respondent shall provide sufficient detail/description in its cost proposal for the City to evaluate the overall quality of the proposed service.

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We would be happy to discuss one bottom-line price, but do not recommend that approach. LWP suggests one fee for all claims adjusting, but separate charges for ancillary services, including bill review, Utilization Review, Nurse Case Management and investigations. LWP utilizes those services so infrequently that we believe any bottom-line estimate will actually cost the City more than our recommended approach. •
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Contract terms and conditions may be negotiated during the agreement process. Respondents are encouraged to provide their best pricing.

Agreed
Please e-mail the cost proposal separately from the rest of the Proposal to Diane Pitman at [email protected].

Cost proposal submitted separately.

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E. SCOPE OF SERVICES
Claims Administration
Provide workers’ compensation claim administration services pursuant to California Labor Code, to include early return-to-work program and utilization review, including bill review and nurse case management. Coordinate workers’ compensation program with any related state and Federal law (e.g. FMLA, ADA/FEHA). The Consultant is responsible for complying with all contractual and fiduciary obligations.

Claims Personnel

1. A dedicated Claims Adjuster and Claims Supervisor shall be assigned to the City’s account along with appropriate support staff. The City retains the right and opportunity to interview, approve and/or reject all proposed individuals to be assigned to the City’s account.

At LWP, we recognize that identifying the right staff for any particular client is part art, part science.

LWP takes very seriously the process of matching the proper Examiner with the client. We consider •
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Client culture and objectives
Relevant experience
Examiner’s caseload (both new loss volume and pending)
Feedback from the client
We offer the following staffing model for the City’s consideration.

Proposed Staffing
1 Account Manager – Partially Dedicated
1 Claims Supervisor – Partially Dedicated
1 Sr. Claims Examiners- Partially Dedicated
1 Future Medical/Medical Only Examiner- partially dedicated 1 Claims Assistant – partially dedicated
Additional support (to include mail room, scanning, check printing, bill payment, trust fund replenishment and balancing and loss reporting) will be provided by our Centralized Services Team)
Upon contract award, we will make candidates available to the City for your consideration.

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This staffing approach will be utilized regardless of whether LWP assumes claims from the prior pool or starts only with new claims. If we manage only new claims, we will still assign them to an Indemnity or Medical Only examiner who can manage the full pending as it grows.

2. Consultant shall at all times have one or more Claims Adjuster assigned to the City. Consultant shall ensure that one or more Claims Adjuster is on call and available to the City every business day throughout the contract period from the hours of 8:00 a.m. to 5:00 p.m. pacific standard time, Monday through Friday.

We commit to having at least one examiner available to the City on all City business days.

We use a buddy system to provide seamless backup for all examiners. Examiners are paired based on complimentary work schedules and similarity of caseload. In staffing the City team, we will ensure that all staff schedules (including PTO) are arranged to ensure at least one member of the team is available to the City on every business day throughout the term of our relationship. Further, our buddy system extends to supervisors and managers to ensure there is always full coverage of both examiners and management.

Caseload, Case Review and Documentation, Claim Creation, Claim Handling

1. Each claim file shall contain the examiner’s plan of action for the handling of that claim, including short and long-term goals and strategy. Such plan of action shall be documented electronically.

We utilize a notepad template to ensure that the plan of action reviews are comprehensive and address all claims issues, including the exposure, compensability, temporary/permanent disability, medical treatment and prognosis and most importantly, the strategy and plan for case resolution.

Those notepad entries can be viewed by the City at any time.

We utilize a dual-track diary approach that achieves the diary objectives outlined by the City by requiring both action diaries as well as plan-of-action diaries. Action diaries are set to find out immediately whether a planned event took place, so that we can ask for an update, and act quickly, often before reports are prepared. In addition to action diaries, every file has a “case resolution” diary, which is worked at least every 45 days for active cases, and at least every 90 days for future medical cases. By taking this approach, we are not only attending to all the various details of handling, but are continually mapping the road to closure, to ensure that all actions are leading us toward a swift resolution.

2. Consultant will investigate questionable claims with coordination, assistance and approval from the City.

Our approach to SIU is consistent with our approach in all other areas. We do not paint all injured workers with a broad brush. We strive for balance, knowing that fraud must be taken very seriously, yet also recognizing that unfounded accusations and mistrust lead to unnecessary litigation and expense.

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In the absence of a specific recommendation from our client, we work with the Dayta Group as our Investigation/SIU partner. The founder and President of Dayta Group has been LWP’s SIU partner since 2004, creating two different teams to proactively fight fraud and create positive claim outcomes. Dayta Group provides LWP with both a compliant and committed Special Investigation Unit (SIU). They provide annual anti-fraud training as well as reviewing suspicious claims upon request. In addition to our joint successes that include 32 convictions and $1.2 Mil in restitution, Dayta and LWP are focusing on prevention, rather than embracing the traditional model of “wait for the lie”, pay, pay, pay and hope to someday get the attention of a District Attorney. We are hoping to send the message to injured workers “Don’t do it here!” The Dayta Group has leading edge ideas and technology to assist in combatting fraud and minimizing exposure for the City. Dayta Group focuses on fraud prevention and claim mitigation as evidenced by their groundbreaking solutions including VeriFive, iConfirm, and MedELink. They are woman-owned, California headquartered, fraud certified, licensed continuing education program providers, and SIU regulatory compliance experts. Dayta Group thrives on innovation, have technical claim expertise, are passionate about data, are relentlessly client focused, ensure operational excellence, and deliver LWP exceptional partnership execution.

Some of their differentiators are:
. Early, proactive investigations focused on approaching employees early on in order to prevent fraud, rather than waiting, waiting, waiting.
. Utilizing advanced technology to conduct background checks that arm us with information in order to approach employees early on in order to prevent fraud, rather than waiting, waiting, waiting.
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On-demand presentations to medical providers that leverage new technologies and AI to make the investigation review as simple as possible for the medical provider Network of investigators available based on client preference and Dayta’s detailed due diligence
Identifying potential cases for a deeper look: Our staff receives regular training in how to identify potential fraud without becoming suspicious of honest and well-meaning injured workers. We utilize a list of Key Fraud Indicators that assist the Examiner in identifying claims that may require additional investigation. Whenever red flags are identified, the Examiner will immediately contact the Employer to discuss and agree on an appropriate plan of action.

Separate from any indications from the client that would trigger a potential referral for an outside investigation; we believe that there are a number of criteria that can be indicators that a field investigation and face-to-face statement taken from the injured worker may be indicated. Those criteria include:
. Employee’s account of incident changes as it is retold

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Employee claims to have “forgotten” to report an important mechanism of injury Employee’s initial account differs from physician’s First Report of Injury Employee fails to report the injury in a timely manner
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Lack of physical evidence to support claims
Alleged injuries appear to be physically impossible
Mechanism of injury is inconsistent with alleged injuries More suspect if incident reported after days off
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Monday morning report of a Friday injury
Claim filed more than a few days after the alleged injury Claim occurs in conjunction with layoffs or announcements of changes Claims occurring after termination
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Multiple prior claims
Frequent address or phone changes
Using a PO Box as a home address
Worker uses addresses of friends, family, or PO Boxes; has no known permanent address and moves frequently.
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Inability to contact claimant at home when totally disabled New hire at employer
Chooses treating physician that is significant distance from employee Tries to treat outside the MPN
Upcoming job change or seasonal layoff immanent
Worker reports an alleged injury immediately following disciplinary action, notice of probation, demotion, or being passed over for promotion Worker has known high-risk activity, such as mountain climbing or snowboarding Worker avoids the use of U.S. Mail; hand-delivers documents Employee is known to have simultaneous employment
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Managing the process: The process is always a collaborative effort between the client, LWP and Dayta Group.

Our approach to utilizing investigative materials is:

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Continually talk with the client to ensure there are no cost Suprises. We seek approval from the client at every step of the process.

Utilize Dayta to assess the quality of the investigative materials to make recommendation about best way to utilize
Assess the materials available and determine whether the case is best approached through an early, proactive approach that prevents further abuse, or whether the case is best approached through traditional SIU methods, focused on preparing a case for law enforcement
. Continually update the client and incorporate into the plan for case resolution.

Communication
Consultant shall:

1. Respond to phone calls or emails to employees within one (1) business day.

We always return phone calls to employees and the client within 1 business day, but generally return them within an hour or two. All communications are clearly documented in the claims system, with the notes available for the client to view at all times.

While LWP will always be proponents of voice-to-voice communications as the most effective communication tool, we do recognize that communication styles are generational and even email is seen as outdated by many of the injured workers we encounter.

As an added tool to facilitate more convenient communications with the injured workers, we implemented LWP CareConnect in 2024. LWP CareConnect was created to solve for some of the biggest obstacles in delivering support to injured workers:

Communication barriers → Text, email, and secure/encrypted messaging with auto-translation .
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Time delays in initial investigation → Electronic questionnaires with risk alerts Mitigating risk in real-time → Automated check-ins, escalation, and intervention Delays in form exchange → Automated document delivery and eSign Staying on top of treatment → Automated alerts, reminders, and follow-ups with appointment guides
. Uncertainty → Display key information, upcoming payments, FAQs, and more! We will automatically send a text message (or email) to injured workers at claims set up with basic information which will assist them throughout the life of the claim in being able to contact us and communicate issues or concerns. Also, the injured worker will gain access to FAQs and other easily valuable information which we hope will assist in relationship development and successful communication. Injured Workers Engagement Platform
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Provides transparency
Streamlines processes
Empowers Injured Workers

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. Identifies claim risks in real time
Key Features of LWP CareConnect
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Messaging
Documents
Appointments
Automated support
Jurisdictionally specific FAQs
Auto translates (100 languages)
Texts/emails from the injured worker are responded to throughout the day, but always within 24 hours.

2. Respond to all written correspondence, phone calls, and emails, from the City within one (1) business day.

We will respond to all communications from the City, regardless of format, within one business day.

3. Respond to all critical issues on the same day.

We believe in returning all phone calls within 24 hours regardless of the time of day. We will attempt to return critical issue calls within an hour or two, at the most.

4. Utilize emails, telephone, fax, scanning and written correspondence with treating physicians in order to secure written physical restrictions and/or limitations as a result of an industrial injury/illness. In addition, the Consultant shall secure written releases for employees returning to modified or full duty in accordance with physician reporting responsibilities as specified by state and federal laws.

We maintain regular communications with treating physicians, setting and reinforcing the expectations that restrictions will continue to be moderated as treatment improves the injured workers’ condition. In cases where we do not see consistent progress toward recovery, we will question the physician about the need for additional treatment modalities and/or diagnostic testing.

In cases where we do not see progress, we will also suggest a change of physicians, if necessary.

Written releases will be obtained for all employees returning to modified or full duty.

5. If the Consultant has not received the Workers Compensation Claim Form (DWC-1) form within two days after receiving report of an injury, the claims adjuster will contact the City to ensure the DWC-1 form was given to the employee within one working day of knowledge of the injury.

If the DWC-1 form was not provided to the employee, the Consultant shall immediately send the DWC-1 form to the injured worker.

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A DWC will be requested during the initial employer contact if not received with claim notification.

Should the report not have been provided to the employee, LWP will provide it immediately.

6. Make initial contact with claimant and establish claim file within 24 hours of receipt of the Employers’ First Report of Injury from the City. Consultant will explain Department of Workers’ Compensation (DWC) benefit notices and other required letters and forms.

LWP will set up a claim and begin the three-point contact process immediately upon receipt of ANY notice of a claim. LWP Examiners are required to make three-point contact claims within 24 hours of receipt, with the first contact always being the employer. If voice-to-voice contact is not achieved, the Examiner will continue efforts to reach the parties until accomplished.

LWP employs a dedicated supervisor level auditor who focuses exclusively on three-point contact.

Her responsibility is to review three-point contact notes to ensure the examiner asked all the pertinent questions and gathered information about all the issues identified at set-up. Once the three-point contact is completed the claim begins a cycle of processing that is continually focused towards closure.

7. Maintain regular contact with injured workers and their physicians with the goal of returning employees to modified or regular work as soon as possible.

We view the injured worker as an extension of our client and make every effort to extend the same level of customer service to the injured worker that we would provide our designated contact person for the client. All calls from the injured worker will be returned the same day.

At LWP, we recognize that ongoing communications with injured workers is a key ingredient in avoiding litigation, returning employees to work and resolving claims quickly. Keeping injured workers informed of the process, their rights and what to expect significantly increases the likelihood of a successful outcome. We are committed to:
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listening first
providing relevant, timely and appropriate communication to the injured worker addressing any concerns raised by the injured worker
contacting the injured worker at least every two weeks while off work encouraging the employer to stay in contact with the injured worker encouraging a prompt recovery
LWP is committed to proactive disability management that is focused on early and sustained Return-to-Work. We recognize the need for early aggressive medical treatment so as to minimize disability and facilitate case resolution. We know that claims resolve quicker when the injured worker is returned to work. While an injured worker is disabled, we contact the treating physicians no less frequently than every two weeks. During the call, we attempt to coordinate release to full duty or, failing that, a return to modified or alternate work. Our staff is trained to probe for information about what an employee is physically ABLE to do, rather than accepting “unable to

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return to work” as a status. We focus on activities of daily living to determine whether we can work with the employer to create modified duties based on those abilities.

Upon contract award, we would like to meet with you to fully understand the City of Foster City’s Return-to-Work Program so that we can most effectively interface. Although we have extensive experience with various Return-to-Work programs, we recognize that each program is designed slightly differently, and want to ensure we design our workflows to interface seamlessly with the City of Foster City.

LWP’s regular contacts with the treating physician are focused on determining what activities the employee is ABLE to perform. We do not accept “unable to work” as a status. We look for the activities that CAN be performed, including activities of daily living. We will then work with the City to determine whether temporary modified work can be available to keep the employee at work.

8. Contact the physician’s office within one to three days after notice of a new claim and shall provide follow-up and intervention with medical service providers on behalf of the City and the injured employee.

A critical component of the three-point contact is the physician contact. We recognize that compensability cannot be effectively determined without a firm understanding of medical history, causality, and diagnosis. Whenever possible, we will resolve these issues during the initial contact with the physician. In cases where the medical causality cannot be readily established, we will consult with the client to discuss various alternatives, which can include an Agreement Medical Examiner or a Panel Qualified Medical Examiner.

In cases where we do not see progress, we will also suggest a change of physicians, if necessary.

9. Be the point of contact for injured workers for assistance with all aspects of the workers’ compensation process, including the explanation of all entitled compensation benefits.

We are committed to being a resource for the injured worker in all aspects of their claim. We commit to explaining benefits, resolving their issues and explaining permanent disability ratings and benefit notices. We are happy to conduct “office hours” at the City’s offices if there is interest in offering face-to-face meetings with employees.

Additionally, we have added materials to our LWP CareConnect application in order to offer resources for injured workers outside of business hours.

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The CareConnect app is accessed an average of 3 times per injured worker outside of business hours. When accessing, the injured worker can read answers to frequently asked questions as well as viewing their payments and other useful information.

10. All valid requests for reimbursement (i.e., mileage, wage loss, out-of-pocket medical expenses) shall be paid to injured worker within thirty (30) days of receipt.

Agreed

11. Meet with and assist injured employees in resolving problems that arise from injury/illness claims as required.

At LWP, we take pride in preventing litigation by becoming a resource for injured workers. Rather than becoming an obstacle, LWP Examiners strive to remove obstacles in order to ease the process for the Injured Worker. We are always available to assist an injured worker, including meeting with them in person. We can hold “office hours” at the City’s offices, if there is interest.

12. Notify the City immediately upon receipt of an employee’s permanent work restrictions so that the City can determine the availability of alternate, modified, or regular work.

We recognize the critical importance of closely monitoring the medical progress of injured workers and immediately notifying you of any indication that there may be permanent work restrictions.

We recognize that you must then engage in the interactive process and then work with the Injured Worker to determine all applicable benefits, as well as the potential for an IDR. We fully understand the critical importance of immediate notification.

Authority
The City reserves the right to approve, disapprove or select all service providers working for or on behalf of the Consultant.

Upon contract award, we will meet with the City to agree on service providers. We are happy to consult on individual assignments, including legal referrals, Utilization Review and Nurse Case Managers. Once there is agreement on the panel of service providers, LWP will coordinate all referrals for the City.

Settlement

1. Consultant shall not approve, enter into, or authorize any settlement, including, but not limited to a stipulated award for permanent disability, or compromise and release for permanent disability, and future medical, without the prior written concurrence of the City.

At LWP, we recognize that all settlement authority rests with the client.

Whenever the opportunity for a settlement arises, (including for 0% PD settlements), LWP staff will prepare a settlement evaluation for the City. The evaluation will include all relevant information including employment status, permanent disability ratings, estimates of future medical care and costs, an evaluation of all legal issues, the rationale supporting the request and the projected ultimate value of the claim along with a proposed settlement range. We will also

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present our recommendation for a settlement instrument (i.e. Compromise and Release, Stipulation, etc.) along with relevant Medicare considerations.

Upon contract award, we would like to understand the City’s perspective relative to Compromise & Release settlements. We have found that for clients who prefer Compromise and Release settlements, that even in situations where the future medical cannot be immediately settled (i.e. injured worker is not interested, or Medicare Set-Aside is exorbitant), there can be some cases where we may recommend a Compromise and Release with open medical treatment. In certain cases, this can serve the advantage of precluding claims for new and further disability, and can leave the door open for a subsequent Compromise and Release of future medical care at a future date.

Except in extraordinary circumstances, LWP will provide a settlement analysis at least ten (10) days prior to any settlement offers or conferences.

2. Settlement proposals directed to the City shall be forwarded by the Consultant or defense counsel, in writing, along with a reasoned settlement recommendation accompanied by supporting documentation required by the City.

Settlement proposals will be provided in writing as requested by the City.

3. Settlement proposals shall be presented to the City in sufficient time to process the request and obtain settlement authorization from either the City or the City Council, as required.

Except in extraordinary circumstances, LWP will provide a settlement analysis at least ten (10) days prior to any settlement offers or conferences.

Claim decisions (delay, accept, reject, and compensability) Consultant shall:

1. Obtain the City’s concurrence and authorization for all claim decisions.

We make every attempt to determine compensability within the first 14 days so that it is not necessary to delay benefits, understanding that issuance of a “delay” letter can trigger litigation.

In all cases, we discuss compensability with our client prior to accepting, delaying or denying compensability. The City will be involved every step of the way.

2. Provide an in-depth analysis of rationale for all recommended claim decisions.

LWP’s approach to evaluating claims is consistent with our approach in all other areas. We do not paint all injured workers with a broad brush. We strive for balance, knowing that it is critical to properly determine compensability while at the same time, recognizing that delaying a claim and/or unfounded concerns about compensability can lead to unnecessary litigation and expense.

Upon receipt, a Claims Supervisor will make recommendations for specific issues to consider during the initial investigation. The supervisor will then review the claim again at 14 days to ensure those issues have been addressed. The input of the City is critical to the proper compensability decision.

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The decision to accept, delay or deny a claim is ALWAYS reviewed with the client before a decision is made. Upon contract award we will meet with the City to ensure that the custom claims handling guidelines include any requirements to collaborate with the City.

For questionable compensability issues, we will strive to complete our investigation within the 1st fourteen (14) days to avoid the need to delay the claim. We find that it is often possible to accomplish this, and to make the determination whether to accept or deny without a delay. By doing this, we can often prevent the litigation that may come from a delay of a claim that will ultimately be accepted.

LWP would never deny a claim without the express approval of our Client.

3. Provide advance notice and explanation of any recommended claim delays or denials at least seven working days prior to determination.

Agreed

4. Establish claim reserves and provide a continual review and update of reserves to reflect changes during the life of the claim.

At LWP, we take reserving very seriously. We recognize that one of our foremost responsibilities is to keep the client continually apprised of their potential liabilities. We understand the impact that reserves have on our client’s ability to assess their actual exposure.

During the initial case evaluation and no later than five business days from the date the claim is originally reported to us, the examiner will establish a reserve that reflects the likely cost of the case based on the available factual and medical information. Subsequent reserve changes are made within seven calendar days of receipt of any additional information. It is our philosophy to ensure that the reserves represent the probable ultimate outcome based on available information.

We do not utilize any formula reserving, or any standard reserves. Whether it is a medical only or an indemnity claim, each claim is reserved based on the specific facts and circumstances surrounding the individual claim. Subsequent reserve changes are made within five business days of receipt of any additional information supporting a reserve adjustment. It is our philosophy to ensure that the reserves represent the likely outcome based on available information.

We stress reserve “accuracy”, rather than “adequacy”, as we recognize that reserves that are higher than necessary are as problematic as reserves that are insufficient. In the absence of specific guidelines from a client, our reserving policies and practices are:

Indemnity - Indemnity reserves are set based on our expectation of the indemnity that will be paid by the time the claim closes. Our indemnity reserve will be based on an estimate of the temporary disability, permanent disability and any vocational rehabilitation component.

Medical - The medical reserve will be based on the Examiner’s best estimate of the medical costs that will be incurred throughout the life of the claim, including lifetime medical care, if relevant.

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Allocated Expenses - The Examiner will set a reserve for the expected expenses for all categories of allocated expense, including legal expenses, medical bill review, Utilization Review, copy service, investigations, etc. The Examiner will use all relevant information in order to project the costs, and will adjust the reserves within 5 days of changing information.

Future Medical Reserves - Future medical reserves are set based on the anticipated level of future treatment. Generally, this is developed by analyzing the most recent three years of medical care, and utilizing an average in order to project the costs based on the injured workers’ life expectancy.

In cases where a pattern is not yet established, the Examiner will work with the client and excess carrier (if appropriate) to determine the proper reserve.

Examiners and supervisors are assigned a reserve authority based on their level of experience and performance. The authority levels are reviewed no less frequently than annually. Reserve authority levels are set not only to ensure that the reserves are appropriate, but also to assist us in identifying cases that need to be reported to the employer, carrier, excess carrier, and other pertinent parties.

Our clients can set thresholds for reserve notification and reporting. When the designated level of client notification is exceeded, the Claims Examiner will consult the client and/or submit the recommendation for consultation.

Claim reserves will be reviewed by the Examiner no less frequently than at each Case Resolution Diary (every 45 days), and with the client at each claim review. Claims Supervisors review reserves on every diary (at least every 90 days) and every time they touch the claim, as well.

Reserve changes must all include documentation as to the reason for the reserve change, and a detailed assessment of the exposures. Examiners will utilize the Origami systems’ built-in Reserve Change Worksheet unless the Client has developed and designated the use of an alternate worksheet. In those cases, the use of an alternate worksheet will be documented in our Client Special Claims Handling Guidelines.

5. Future medical claims shall remain open for two years from the last payment of any benefit.

Reviews shall be documented in the claim notes to include settlement information, future medical care outline, last date and type of treatment, name of excess carrier, excess carrier reporting level, and excess carrier reporting history.

At LWP, we do not “monitor” future medical claims—we “manage” them. We review requests for medical treatment very carefully, considering medical necessity, consistency with the award (body part, type of treatment awarded, etc.) and possibility of new injuries. We work closely with excess carriers, and also look for opportunities to reduce the need for ongoing medical care, including weaning injured workers from long-term medication use.

Throughout the life of the Future Medical claim, we continue to do the following:

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• Review the Award – to insure there has been no “creep” in the future medical treatment.

We remain vigilant that no additional body parts or medications or treatment protocols are requested that are not consistent with the awarded treatment. •
•
Review the P&S report on which the Award was based – This insures that any of our team members who review the claim accurately interpret the Awarded treatment.

Consider wean-down treatment to reduce dependency on pain medications – Overutilization of expensive medications is often the barrier to a cost-effective settlement of future medical cases. Acknowledging that this can be a very difficult challenge, we have had some success in reducing the dependence on medications substantially enough to posture a case for a cost-effective settlement.

Compromise and Release settlements are considered at every juncture. Should the case require a Medicare Set Aside, we would consult with City to determine if it makes sense to consider a settlement. We believe that it is generally possible to predict the Medicare Set Aside values (at least a ballpark value) which can give City an indication as to whether there may be any interest in a settlement. If it is likely that the MSA would result in a prohibitively expensive settlement, we always recommend against pursuing the MSA.

We review reserves at every touch, and do a thorough reserve review at each plan of action review, at least every six month, reviewing the employee’s life expectancy, recalculating the three-year average and considering any changes in treatment patterns and/or other new information.

This review is clearly documented in the notepad and the rationale for any changes is further documented on the Reserve Worksheet. Both create permanent records in the claim file and are available for the Client to review electronically at any time.

Litigation and Investigation

1. The City must authorize all investigative and sub-rosa activities.

Agreed

2. Consultant and the City shall ensure that Defense counsel provide a written analysis of each case at intervals specified by the City.

Agreed

3. The City shall be informed of any settlement offers received from the claimant or claimant’s legal representative.

Agreed

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4. The City shall be informed of all hearings, conferences or trial dates set by the Workers’ Compensation Appeals Board. At the request of the City, the Consultant will attend hearings at no charge to the City.

Agreed

5. Consultant will represent the City in all matters related to the set-up, investigation, adjustment, processing, negotiation and resolution of workers compensation claims against the City.

Agreed
Reporting to Excess Carrier
Consultant is responsible for reporting any potential excess workers’ compensation claims in accordance with carrier guidelines and policy provisions and for maintaining liaison between the City and its excess insurer on matters affecting the handling of such claims and arranging for reimbursement to the City of losses in excess of its self-insurance retention level.

We view this as a core responsibility and commit to complying with all excess reporting requirements.

Upon contract award we will meet with the City to identify your excess carriers for all years, and to discuss the format for reporting to each carrier.

File and Program Review Meetings

1. The Claims Supervisor and Claims Adjuster assigned to the City’s account will hold quarterly claim review meetings with the City. The purpose of the quarterly file review meetings is to reach agreement about claim strategy for challenging claims, to identify problems, to focus on defense strategies and case resolution as well as to discuss trends and adjustments in the workers’ compensation program.

At LWP, we believe that claim reviews are a valuable tool in achieving superior claims outcomes and that the information that can be gleaned from the conversation makes the time and expense well worth the investment. We further believe that those meetings should also contain a Stewardship component. We will provide standardized and customized Stewardship reports along with issues, trends and recommendations for program improvements.

We are happy to provide our recommendations for claims to review, but ultimately the City will determine which claims you choose to discuss. Once we have received the list, we will prepare Plan of Action reports that can be delivered electronically to you prior to the meeting.

We do believe that the meetings should be face-to-face, if possible, to maximize the benefits of collaboration.

Either during the claim review meetings, or separately, we will plan to prepare stewardship reports that detail trends, issues and identify potential program enhancements to address those trends.

Our stewardship reports will be customized for the City, but can include very detailed trending information by Union, by Department, by occupation and by a host of other characteristics. This

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information can assist with targeting loss prevention dollars and resources to the areas of largest potential impact.

2. Consultant shall require Claims Adjustor to meet with the City personnel, at the City’s location, at least once annually to review program procedures regarding workers’ compensation reporting requirements and other program matters.

We would hope to meet with the City more frequently than annually to review procedures, special handling requirements and program trends and status. We are happy to do this quarterly, or at any frequency preferred by the City.

Audit

1. Consultant must maintain organized and well-documented claim files for each reported loss, which shall be available for audit by the City or its assigned representative.

Claim files are set up electronically at LWP. We will maintain any paper that is sent to us from a prior administrator but will not add any paper to those files.

Our claims are available for inspection 24/7 via online access by the City and/or your designees.

The electronic claim file includes:
.
.
.

Full description of the accident and injury
All relevant coding
Financial information including payments, outstanding reserves, recoveries and total incurred values
.
.

All Examiner notes
Relevant Documents

2. Consultant must cooperate fully with, provide requested information to, and respond to recommendations and findings of the City audit and actuary consultants.

LWP is happy to cooperate with any auditors or representatives authorized by the City. Audits can be performed with or without prior notice. LWP will comply with all audit findings and recommendations of actuary consultants.

3. The City reserves the right to conduct financial audits of the trust account to ensure the integrity of the account.

The City is welcome to audit at any time with or without prior notice.

Regulatory Updates
Consultant shall provide the City with information regarding changes and proposed changes in statutes, regulations, and case law affecting the City’s workers’ compensation program.

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If there is a law or regulation change that immediately impacts the City, we will ensure that the City is provided with the necessary information and recommendations to facilitate the change. Further, it is anticipated that trends and changes in the workers’ compensation system will be discussed in the claim review process. From time to time, we recommend that assigned defense counsel attend claim reviews so that they can not only assist in facilitating proper case management and closure, but to bring the parties up to date on any legal reforms.

Employee Training

1. Consultant shall provide training to the City personnel involved in the administration of the City’s workers’ compensation program.

LWP offers our clients customized Workers’ Compensation training. We will develop modules to meet specific requests. We are happy to commit to the three training sessions requested but are also happy to provide any additional sessions or training that the City may find helpful. We do not limit the number or frequency of training provided to any client and are happy to conduct the sessions remotely or in person.

Some topics of frequent interest to clients include:
-
-
-
-
Introduction to Workers’ Compensation (WC 101)
The role of the employer in WC claims
The role of the supervisor in WC claims
Strategies for Successful Return-to-Work
Additionally, for issues that impact all clients (as SB 1159 and AB 685 did during the pandemic), we have offered webinars. These webinars are recorded so that we can offer the recording to clients who are unable to attend the actual sessions.

Additionally, we regularly route updates to our clients, as well as developing PowerPoint presentations for our clients. We can commit to keep the City’s risk management staff up to date on legal and case management trends via regular communications.

2. Consultant personnel shall be made available to the City on an “as needed” basis to provide City- wide supervisory and employee training on topics of interest to be determined by the City pertaining to the workers’ compensation program at designated City locations.

Our team provides clients with training services frequently. We are more than happy to provide training customized to the City’s specifications.

Reports

1. Consultant shall maintain all loss information as required by the Workers’ Compensation Insurance Rating Bureau.

Agreed

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2. Consultant will prepare the annual CAL-OSHA Log 300 and the annual Public Entities Self-Insurers Report as required by the department of Industrial Relations, Self-Insurance Plans. Reports are to be submitted to the City no later than 30 days prior to the due date.

OSHA 300 and 300 A reports are available in our system. Data is automatically input into the report, and the reports are produced in Excel format, allowing the Client to edit the data to exclude any non-reportable claims, and to add any additional information to each claim.

Data is collected based on indemnity payment requests which capture the dates of disability.

Additionally, Examiners track modified workdays in order to give the Employer a complete picture of Disability information.

LWP is able to produce all required reports for the State. LWP has several experienced staff members who regularly prepare the annual reports required by the Office of Self Insurance Plans.

We will prepare the claims portion and will provide it to the City with plenty of lead time to allow the City to add the portions required by the Employer.

Forms

1. Consultant shall provide at its expense, all forms, posters and pamphlets required by applicable laws, rules or regulations affecting its services.

Agreed

2. Consultant shall develop, for review and approval by the City any materials, which the City determines will provide needed or helpful information and guidance to the City employees regarding the workers’ compensation and/or self-insurance program.

Agreed
Penalties

1. Consultant shall provide its services in a timely manner and in compliance with statutory requirements.

LWP is known for our highly developed sense of urgency.

LWP is very diligent about timeliness and rarely incurs penalties. We voluntarily self-impose any penalty that results from our actions and immediately reimburse our clients. This extends to any overpayments that we cannot recover, as well. Additionally, we will provide a full accounting of any penalties incurred, along with a plan that would include any remedial steps taken to avoid future penalties.

LWP will establish a workflow to route penalty reimbursements as requested.

2. All fines, citations, penalties or other assessments assessed because of a failure to comply with statutory laws and/or administrative regulations shall be the sole responsibility of the Consultant.

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We consider this to be a core responsibility. Although penalties are rare at LWP, we do self-impose 10% penalties whenever a payment is late.

3. Consultant will reimburse the City within 30 days for any fines, citations, penalties or other assessments assessed against the City, unless the City agrees that noncompliance was not the responsibility of the Consultant.

Agreed

4. Consultant shall provide a detailed monthly listing of all assessed fines, citations, penalties or other assessments, identifying the responsible party. Consultant’s responsibility for fines, citations, penalties and other assessments shall survive the expiration or early termination of the Agreement.

Agreed
Workers’ Compensation Account

1. The City will establish and replenish a bank account from which all Workers’ Compensation benefits and expenses are to be paid. (Other administrative procedures can be considered if proposed by the Consultant.)
At program implementa�on, we will work with the City to develop a pre-approval process so that bills are paid in a �mely manner. The City will be provided support (inclusive of mail room, scanning, check prin�ng, bill payment, trust fund replenishment & balancing, and loss repor�ng) by our Centralized Services Team.

LWP has a dedicated banking team that is always available to the City. They can provide any repor�ng needed, both scheduled and ad hoc. They regularly reconcile accounts (by the 15th of each month, unless required earlier by a client), analyze the funding adequacy, provide historical repor�ng as well as recommenda�ons and support. The City can modify your banking arrangements at any �me.

We rou�nely provide check stock, manage replenishments, build and manage two-way posi�ve pay feeds to various banks, and provide all accoun�ng and reconcilia�ons. We can provide both standard and customized reports to meet the City’s accoun�ng needs.

LWP takes very seriously our responsibly for ﬁnancial integrity. Among the many ac�ons we take to ensure quality and ﬁscal integrity are:
▪
▪
▪
▪
Reconcilia�on of accounts every month
Implementa�on of posi�ve pay for client checking accounts Careful separa�on of du�es to limit the opportunity for fraud Automated duplicate checks on payments even on bills that have been through bill review

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▪ Supervisory oversight of reserving including automated safeguards on the amount of reserve changes including client involvement on large transac�ons Adjuster approval of all bills prior to payment or bill review with extensive audit trails Extensive management reports on system access, roles, and authori�es Automated data integrity checks in both medical and straight pay Double-blind keying of straight pay bills
Payment checks on medical bills
Vendor W-9 setup by two individuals with no ability to make payments Valida�on of tax ids against the IRS database
▪
▪
▪
▪
▪
▪
▪
▪ All client data feeds are cross checked against loss runs at speciﬁed �me intervals

2. Consultant will provide a weekly register of checks issued and all expenditures.

Agreed
Database Management Services

1. Consultant must maintain accurate and timely loss runs, in a format and system acceptable to the City, and establish adequate reserves and post indemnity, medical supplemental job displacement benefits and loss adjustment expenses.

LWP maintains very robust reporting capabilities. We deliver reports via several methods:
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.
.
.
.

Losses reported by tenure with Company
OSHA 300 and 300A
Check Registers
Individual Claim Reports (Notes, reserve activity, plan of action, etc.) Standard reports templates allow user to specify:
.
.

Spreadsheets can be sorted, formatted and manipulated to allow maximum access to their data.

Data from the prior administrator will be made available through this tool (subject to the quality and availability of that data). All reports are exported to Excel spreadsheets. Reports can be stored and edited for re-use. All data in the report can be as of a user specified value-as-of date or current to that instant in time.

Customized reports prepared by LWP staff: LWP maintains staff with expertise in creating customized reports. You will have unlimited access to our staff and can request ad-hoc or customized reports at any time. We employ a full-time analyst with very advanced capabilities in order to assist clients with advanced reporting and analysis needs.

Stewardship Report: LWP has developed a package of risk management reports that includes high- level and detailed information in both data and graphical format. These reports will be provided at

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claim reviews to provide an overview of trends and results. Additionally, LWP can commit to creating reports that are needed for any risk management meetings.

Sample reports are included as Addendum E.

2. Consultant must provide monthly loss runs to the City showing open and closed claim summaries by department.

Agreed

3. Consultant must provide monthly loss runs of all pending claims, which shall include: (1) a report of all claims by current fiscal year by department; (2) the current month new claims and closed claims; (3) all claims by date of injury by fiscal year; (4) all claims by payment type; and (5) all active claims in alphabetical order by department. Claim information shall include employee’s name, number, position, organization code, facility location, brief description of injury, location of injury and paid and reserve amounts. These reports shall be customized in a manner acceptable to the City.

LWP can provide this report in any format preferred by the City.

4. Consultant must provide online access to claim files and claim reporting capability. Such access shall be provided for a minimum of two (2) City users.

LWP offers clients access to the Origami system, allowing the City to do the following:
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.
.
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Report claims to LWP online
View a customized dashboard with metrics relevant to the City View individual claims details (including financials and adjuster notes) Run reports
Total number of users and their assigned authority levels to access the City’s data/ information will be confirmed at program implementation. The City will be provided four (4) user ID’s, at NO COST, additional charges may apply for any number of users beyond this amount.

5. Consultant’s system shall have the capability to separately track lost time, days of modified duty assignments and temporary partial disability.

LWP is able to track all specified data along with all other workers’ compensation specific requirements.

6. Consultant’s system shall have the capability to record actual temporary and permanent disability indemnity exposure, listed separately for reserve purposes.

LWP’s claims system, Origami Risk, and our recordkeeping practices allow us to meet the requirements. Our reserve worksheet (built into Origami) separates temporary disability (including 4850 TD) , permanent disability and 4850 differential.

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7. Provide an annual loss run of all (open and closed) City claims.

Agreed

8. Consultant or the City may propose additional tasks as deemed necessary to complete the assignment. Any additional work shall be negotiated and ordered through the issuance of an approved Task Order.

Agreed
Record Retention and Ownership

1. All records, files transcripts, data and other materials related to the management and administration of the City’s workers’ compensation claims shall remain the property of the City.

LWP understands that all data and information is the property of our clients and will not destroy data without the express prior approval of the City. Should prior claims be transferred to LWP any documents associated with those claims would not be destroyed without the consent of the City,

2. Records shall be maintained in accordance with statutory time requirements and shall not be destroyed without the written permission of the City.

Claims records are kept electronically at LWP. Once LWP becomes the administrator, no new paper will be created, unless required by the City. Should prior claims be transferred to LWP, we will maintain and store any paper files sent to us at time of take-over and will maintain those in an orderly manner to meet all statutory file retention standards. For electronic data, LWP maintains all electronic records for the life of our relationship. Should the relationship end, the records will be transferred to the administrator of the City’s choice.

3. Records must be maintained in good condition. Records should be relinquished to the City upon request or upon the natural expiration or termination of the agreement.

All records will be maintained in good condition and as they are the property of the City, will be returned to the City upon request.

Subrogation

1. The City will make all decisions regarding who and in what manner the City will proceed against responsible persons, agencies and/or agents in subrogation action, in an effort to receive apportionment or otherwise recover losses suffered by the City due to injuries or illnesses inflicted on its employees.

At time of investigation, the examiner will document the investigation and subrogation and/or apportionment potential in the claims system. Those notes will be available for viewing through on-line access and are also included in our Plan of Action report. LWP will consult with the City on all potential subrogation cases to ensure that we have a proper understanding of relationships so

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that we can aggressively pursue subrogation when appropriate, but do not interfere with any of the City’s relationships inadvertently.

We will present our evaluation of the cost/benefit of pursuit for the City’s consideration. We will then continue to update our cost/benefit analysis as facts change. You will be involved every step of the way.

We will also present our assessment of the possibility of apportionment as part of any settlement proposal we provide to the City.

2. If requested by the City, Consultant shall proceed against such responsible persons, agencies and/or agents. Consultant shall consult with the City about its subrogation efforts to obtain prior concurrence and authorization. Consultant shall vigorously investigate and pursue all potential subrogation and apportionment issues on behalf of the City.

Once authorized by the City, responsible parties will be put on notice within 10 business days of a determination, with an appropriate claim filed within six months. All related information will be documented in the notepad and available for review by the City at any time.

Transition Plan; File Storage
Consultant shall be responsible for the cost and execution of the conversion and/or establishment of loss run database and file transfers, including documents and images from the previous TPA and shall assume responsibility for the storage of physical files at a site other than City property.

Should prior claims be transferred to LWP, LWP will take responsibility for both the cost and the execution of the data conversion and upkeep, as well as for the storage of all physical files.

Affiliation Disclosure
Consultant shall disclose any financial relationships, arrangements, or inducements with vendors that will work with Consultant on City claims. In addition, Consultant shall disclose all subsidiaries financially linked to their organization. Such disclosures shall be made prior to approval of the agreement and shall be continuously maintained and updated throughout the term of the agreement.

LWP is a standalone Company with no affiliates. We do not accept any compensation from vendors or other companies, and do not participate in sliding scale volume discounts.

LWP does purchase some services at “wholesale” rates and then charge a “retail” fee that includes LWP’s considerable oversight management.

Financial Services

1. Provide daily documentation of all checks issued on City claims to the City Finance Department.

Agreed. This can be provided via email or uploaded to a secure FTP site, if preferable.

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2. Provide weekly documentation of all temporary disability benefit payments issued on City claims (including dates covered by payment and payment amount) to the City Finance Department.

Agreed. Upon contract award, we will work with the City to determine the exact format preferred by the City.

3. Consultant, as agent for the City, shall maintain a bank account with a federally insured bank and shall have sole signing authority on said account up to $5,000 or other agreed upon amount.

Payments exceeding $5,000 or other agreed upon amount shall require a second signature, by a City signatory. The City will be responsible for maintaining a balance in the account in an amount to be determined by Consultant and the City.

At LWP, we recognize that each client has unique banking needs and preferences. We have experience working with clients who choose a variety of banking arrangements, including:
.
.
.
zero Balance accounts
trust accounts maintained by LWP
accounts maintained by our clients
Upon contract award, we will meet with the City’s banking team to determine your exact specifications.

We do not set out specifications, but rather adapt to the client’s needs and preferences.

LWP has a dedicated banking team that is always available to the City. Our team can provide any reporting needed, both scheduled and ad hoc. We regularly reconcile accounts (by the 15th of each month, unless required earlier by a client), analyze the funding adequacy, provide historical reporting as well as recommendations and support. The City can modify your banking arrangements at any time.

We routinely provide check stock, manage replenishments, build and manage two-way positive pay feeds to various banks, and provide all accounting and reconciliations. We can provide both standard and customized reports to meet the City’s accounting needs.

LWP takes very seriously our responsibility for financial integrity. Among the many actions we take to ensure quality and fiscal integrity are:
.
.
.
.

Reconciliation of accounts every month
Implementation of positive pay for client checking accounts Careful separation of duties to limit the opportunity for fraud Automated duplicate checks on payments even on bills that have been through bill review
. Supervisory oversight of reserving including automated safeguards on the amount of reserve changes including client involvement on large transactions Examiner approval of all bills prior to payment or bill review with extensive audit trails Extensive management reports on system access, roles, and authorities Automated data integrity checks in both medical and straight pay Double-blind keying of straight pay bills
Payment checks on medical bills
Vendor W-9 setup by two individuals with no ability to make payments Validation of tax ids against the IRS database
.
.
.
.
.
.
.

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. All client data feeds are cross checked against loss runs at specified time intervals Should the City select a bank with which LWP does not currently have a fully automated positive pay feed, we will build one at no cost to the City. LWP couples this with daily reconcilement to ensure that in clearing items match the items issued by LWP. Positive Pay allows LWP and the client to:
.
.

Identify unauthorized transactions including counterfeit or altered checks before final payment
Effectively monitor bank balances and funding requirements by monitoring issued checks daily
.
.

Reduce the risk of over-the-counter encashment of unauthorized items Gain complete, customized control over the check disbursement process

4. Consultant shall promptly forward to the City a copy of each check drawn upon the trust account.

All canceled checks drawn upon said account and the bank statement for the account shall be forwarded monthly to the City Finance Department.

Agreed

5. Upon termination of the subsequent Agreement, Consultant shall issue a check payable to the City in the amount equal to all unexpended funds remaining in the trust account as of the effective date of termination.

Agreed

6. Any interest earned in the trust account shall accrue to the City’s benefit. Consultant shall issue 1099, Miscellaneous Income Tax Forms, for all vendors paid by the City through the Trust Account.

Agreed
Medicare Secondary Payer Mandatory Reporting Requirements Consultant is responsible for the reporting of claims and compliance with the Medicare Secondary Payer Mandatory Reporting Requirements under the Medicare, Medicaid, and SCHIP Extension Act of 2007 for the City’s self-insured workers’ compensation program.

LWP will provide Medicare Agent Services and required reporting as indicated. Unless otherwise specified by the City, reporting will be completed via our integration with our partner, the Sanderson Firm.

Deliverables
Consultant deliverables include but are not limited to:

1. Workers’ Compensation claim administration services pursuant to California Labor Code.

Agreed

2. Monthly, quarterly, semi-annual and annual computer runs and reports.

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Agreed

3. Quarterly management reports.

Agreed

4. Annual report of findings following a review of open cases and reserves to be submitted to the City prior to April 1st of each year.

Agreed

5. Statistical data for the Self-insured Annual Report to be submitted to the City prior to September 1st of each year.

Agreed

6. Written file review, including recommendations for handling case to its conclusion if the case remains open after six months.

Agreed

7. Written settlement authorization request for each case resulting in permanent disability, Findings and Award, or Decision and Order.

Agreed

8. Medicare Reporting pursuant to MMSEA Section 111.

Agreed

9. Provision of appropriate claims forms, Employer’s Report forms and posting notices.

Agreed

10. Weekly report of temporary disability payments provided to the Finance Department.

Agreed

11. Daily check registers provided to the Finance Department.

Agreed

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LWP has a proven track record for disciplined execution. We have documented those practices that we are confident lead to outstanding results in most cases. We encourage these practices, and measure and monitor our examiners’ performance to be sure that our Best Practices are utilized. We know that the difference between excellence and mediocrity is in the blocking and tackling that occurs each and every day. Yet, we also recognize that even tried and true techniques are not always the best course for any particular claim. Our examiners are empowered to evaluate the circumstances of a claim and to document and pursue a course of action that is likely to lead to a better result for a particular claim. We want our examiners to “do the right thing,” rather than merely “doing things right.” Table of Contents
Staffing ............................................................................................................................... 2 Client Service...................................................................................................................... 4 Claims Management........................................................................................................... 5 Claims Processing ............................................................................................................. 17 Banking............................................................................................................................. 19 Systems............................................................................................................................. 20

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Staffing
LWP hires and retains competent, motivated personnel to provide services to our clients. All technical team members are certified, including claims managers, claims supervisors, claims examiners and pertinent support staff.

We assign designated claims examiners to each client to ensure personalized service for the employer and program manager. Staff is assigned based on our assessment of the “fit” with the client. Clients are always invited to interview our staff prior to assignment. Additionally, we will remove any examiner or supervisor from a client if we determine that there is not a good “fit’, or if requested by the client.

Bi-Lingual examiners are assigned to clients based on need and availability.

Staff Selection LWP puts tremendous emphasis on staff selection to maximize the likelihood that new staff members will be successful in our results-oriented environment. As candidates are identified, we utilize our 360° Recruiting Process to ensure that we optimize the chances of making successful hires. The process ensures that the new employee can meet both internal and external expectations. Some of the key areas that must be evaluated when determining Examiner competence are:
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Technical Knowledge
Customer Service Focus
Communication Skills
Organizational Skills
Our process is:
. Phase 1- Candidate provides resume and completes application (HR will screen to ensure applicants meet minimum requirements of each position, including proof of State Certification and Self-Insurance Certificate)
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Phase 2- Qualified candidates will interview with hiring supervisor or manager Phase 3- Candidate must satisfactorily pass a background check (including credit and criminal) Phase 4- Candidates that pass hiring supervisors’ interview will participate in a peer interview, as well as interviewing with a second supervisor
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Phase 5- Candidates that pass Phase 4 will interview with claims manager/vice president (and president for supervisor or manager positions)
Phase 6- Candidates that pass Phase 5 will interview with client (if desired) Note that multiple phases can be completed on the same day.

Training and Development: At LWP, we believe that training and development of our staff is critical to the success of our operation. LWP goes well beyond meeting the statutory requirements for our staff. We utilize a combination of industry courses and in-house training sessions. We conduct a minimum of one in house training session each month for our technical claims staff in addition to sending our staff to industry courses and other relevant educational sessions.

All staff meet State Certification requirements, including:
. 24 hours of annual continuing education for supervisors and managers . 15-24 hours of annual continuing education for claims examiners (depending on examiner level) In addition to ensuring that these requirements are met, LWP also ties advancement and promotional opportunities to educational and training development. No matter how exceptional an examiner’s performance might be, they cannot be promoted without completing industry designations, including the Self-Insurance Certification. LWP requires this LWP Claims Solutions – updated March 2023 Page 2

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certification for all examiners who manage claims for self-insured clients and encourages certification for those not assigned to self-insured clients, so that all examiners are qualified to pinch-hit and step in to assist other Examiners. All staff and management are fully trained in the rules and regulations governing claims and medical management, including AMA and ACOEM guidelines.

Performance Management LWP takes performance management very seriously. We measure and monitor many aspects of the work and take our clients’ feedback very seriously. Our performance management approach includes:
. Daily monitoring of certain tasks
. Weekly supervisors’ reports to include both quantifiable objectives, and qualitative narrative comments on exceptions
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Monthly KPI reports
Monthly supervisory and management performance recaps
Regular feedback from clients (via all sources, including our management “chat calls”) Any time a staff member does not meet client needs; we will work with the client to determine whether they support performance counseling and training, or whether they prefer removing the person from their account.

Staff Retention LWP takes an active approach to preventing unwanted turnover. Our approach includes:
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Competitive salary and benefits to all employees
Professional work environment that includes private offices for Examiners, based on seniority Alternative work schedules (subject to client approval.) Supervision Managers and supervisors do not carry caseloads. It is central to LWP’s handling philosophy that managers and supervisors dedicate their time to overseeing the adjusting process. The supervisor’s principal responsibility is to evaluate the examiners’ claims handling and provide feedback to ensure that all actions are proactive, timely, accurate and cost effective.

Our supervisory program outlines the specific requirements that supervisors monitor. In addition to ensuring that all claims are reviewed by a Supervisor at least semi-annually, we require supervisors to sign off on a number of adjusting steps before examiners can proceed. The following actions are all reviewed by a supervisor before completion. The supervisor’s approval is noted in the electronic claim file before the action is taken. (Those approvals will be visible through electronic access.)
Notepad entry of any claims reviewed for:
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Initial Intake- assignment and direction to examiner
14 day- initial review (if claim delayed)
28 -day new loss oversight review (if claim accepted)
Delay approval
Denial approval
Acceptance approval (if originally delayed)
Reserve change approval (items over examiner’s designated authority) Settlement approval (items over examiner’s designated authority) Award computation sheet approval
Regular 90-day review to assess progress and offer feedback and direction Penalty payments approval
Closure approval
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The first step in the supervision process is to ensure that all claims have 3-point contacts within 24 hours. To ensure that this is accomplished, our claims system creates automated diaries to the Examiner on date of new loss, and posts the progress of 3 point contacts to the supervisor’s dashboard.

The supervisor next looks at the file at either 14 or 28 days. All files receive a 28-day diary. This allows the supervisor to assess the quality of the 3-point contact, identify any issues that may need further investigation and to provide direction to the examiner. A supervisor’s input will be documented in our system as a “supervisory review” note.

Supervisors are very involved in the handling throughout the life of the claim. They attend client claim reviews, complete targeted reviews to spot particular issues (i.e. large losses, etc) and also must approve various adjusting steps, as listed above. Our Best Practices also direct them to have a meaningful supervisory footprint in each file at least every 90 days, maintaining ongoing oversight diaries until case closure.

Finally, no file can be closed without a supervisor’s review to ensure that all benefits have been properly paid, all notices properly sent and all issues have been resolved.

Client Service
Client Service Philosophy We pride ourselves in offering a customized claims product to our clients. No two clients have the same workflows or service needs. We start by asking the client what is needed and wanted. Then, we provide our claims expertise so that we can create customized best practices to fit the precise needs of the client. If the client develops a new need for which a solution is not already in place, we will find one or build one.

Once we customize the services, we will memorialize the agreements into Client Special Handling instructions, which are distributed to all staff regularly. The instructions will be reviewed regularly, and any changes will be updated immediately. Nothing is ever set in stone. If the client wishes to see changes, there will be changes.

Client Communications It is anticipated that our claims staff will have regular contact with each client, often daily.

Communication flow will likely be a combination of telephone calls and emails, in addition to regular meetings. LWP scans all new hard copy documents we receive, allowing most documents to be transmitted electronically, either by email or fax, or by posting to a secure FTP site. LWP’s clients are generally very involved in their workers’ compensation programs and, as such, we are accustomed to a high degree of communications with employers and clients. To that end, we feel that it is very important to involve our clients in both routine and high level issues to ensure the maximum level of claims management is being provided. Successful claim outcomes can be traced very specifically to collaboration between the employer and the administrator.

Upon award of the contract, LWP meets with each client to establish specific protocols for communication. To ensure compliance, these protocols will be reviewed with the claims team and published internally in our Special Claims Handling database.

Claim Reviews and Status Reports The claim review is a forum for discussing the status and direction of the claims with our clients. We openly discuss claim issues and employer issues. We strongly believe that the client’s input is essential to effective case resolution. LWP will establish a claim review schedule that meets the individual needs of the client.

We generally recommend quarterly reviews and encourage face-to-face reviews where practical.

Any client requesting a status report will receive a copy of the latest plan of action within five business days from the date of the request.

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Loss Reports LWP will provide monthly loss runs to each client and any designated program manager. Loss runs will be emailed to clients as PDF or Excel files, depending on the preference of the client.

Account Management At LWP, we believe that account management should be viewed as “management” rather than as a “sales” function. Unlike most in the industry, we do not employ separate Account Managers. Our claims managers are our account managers. We do this because we believe that this is consistent with our culture of accountability.

Account managers will stay in regular contact with our client, seeking out feedback in addition to coordinating claim reviews, stewardship meetings and responding to any and all requests.

File Access LWP maintains an orderly electronic claim file for each claim. Claims that originated prior to April 2008 may also have a paper file with documents dated prior to April 2008. For files assumed from another TPA, we will maintain any paper files that are existing, and will scan the relevant documents (ie. Award, MMI report, etc.) Once we assume the claim, no further paper will be created.

We will then maintain the paper files either in our office or in off-site storage. Files are available to the carrier, the carrier’s designee, or the self-insured employer (within Statutory Regulations), with or without notice.

Claims Management
Case Evaluation Once the claim is assigned to the examiner, the case evaluation process begins. Initial case evaluation begins within one business day from our receipt of the new claim.

For claims appearing to be medical only in nature, the assigned examiner will make a two-point contact with the employer and physician to ensure that the claim is for a valid employee, that there are no questions regarding compensability, to verify that the employee is not losing time from work, and to confirm the diagnosis and treatment.

During this initial triage, the examiner will also determine whether there is any potential for subrogation. If subrogation is indicated, the loss is escalated to an indemnity examiner.

For claims appearing to be first aid in nature, the examiner will make a one point contact to speak with the employer and confirm the facts, compensability and that there has not been any treatment beyond first aid.

For claims appearing to be indemnity in nature ,claims examiners will conduct the more extensive case evaluations that indemnity claims require. The evaluation will include all the following items:
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3-point contact with the employer, physician and employee A decision to accept, delay or deny the claim
A determination of the appropriate benefits and notices to be sent Identification of any subrogation potential and initial investigation Medical and disability management
A complete reserve analysis
Diary schedules to ensure prompt and appropriate claim handling Investigation
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At LWP, a prompt and thorough investigation answers the questions of “who, what, when, where, why and how.” A prompt inquiry to determine the facts while the events are still fresh in everyone’s mind promotes the Claims Examiner’s ability to control and coordinate management of the claim.

Upon receipt, a claims supervisor will make recommendations for specific issues to consider during the initial investigation. We require supervisors to approve any claim delay or denial, and to verify that client consultation and approval has been secured before our supervisor can approve.

The three-point contact is completed within 24 hours, giving us as much time as possible to attempt to complete the full investigation without the need to send the Delay of Benefits letter. Knowing that a delay letter contains legal language that often drives an injured worker to an attorney, we try to avoid the Delay letter if possible, in favor of completing the investigation and determining (in consultation with the employer) whether the claim will ultimately be accepted, or will be denied.

We recognize that claim investigation is critical to determining issues of employment, compensability, benefits, subrogation and safety hazards or violations. Claim investigation begins with the 3-point contact process. During the initial claim investigation, information may be uncovered that raises further questions and the need for a more extensive investigation. When these situations arise, the Examiner may recommend the use of an outside investigation, depending on the facts of the case.

Separate from any indications from the client that would trigger a potential referral to an outside investigator; we believe that there are a number of criteria that can be indicators that a field investigation and face-to-face statement taken from the injured worker may be indicated. Those criteria include:
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Vehicle accident
Other than employer’s premises (slip and fall, water hazard, damaged walkways, sidewalks, etc.) Machinery or equipment failure
Assault (human or animal)
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Employee’s account of incident changes as it is retold
Employee claims to have “forgotten” to report an important mechanism of injury Employee’s initial account differs from physician’s First Report of Injury Employee fails to report the injury in a timely manner
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Claim filed more than a few days after the alleged injury Claim occurs in conjunction with layoffs or announcements of changes Claims occurring after termination
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Worker has known high-risk activity, such as mountain climbing or snowboarding Worker avoids the use of U.S. Mail; hand-delivers documents Employee is known to have simultaneous employment
If the examiner recommends delay a claim for additional investigation, the client will be notified of the basis for the delay and the actions the examiner will take to promptly complete the investigation so that a decision can be made as quickly as possible. The Examiner will then contact the client again once a recommendation to accept or deny the claim has been developed.

Each indemnity claim is reported to the ISO and EAMS systems to check for prior and concurrent injuries.

All delayed claims will be accepted or denied within 90 days.

Communicating with Injured Workers At LWP, we recognize that ongoing communications with injured workers is a key ingredient in avoiding litigation, returning employees to work, and resolving claims quickly. Keeping injured workers informed of their rights, the process and what they can expect increases the likelihood of a successful outcome significantly. We are committed to:
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listening first
providing relevant, timely and appropriate communication to the injured worker addressing any concerns raised by the Injured Worker
contacting the Injured Worker at least every two weeks while off work encouraging the employer to stay in contact with the Injured Worker encouraging a prompt recovery
We view the injured worker as an extension of our client and make every effort to extend the same level of customer service to the injured worker that we would provide our designated contact person for the client. All calls from the Injured Worker will be returns on the same day.

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Reserving At LWP, we take reserving very seriously. We recognize that one of our foremost responsibilities is to keep the client continually apprised of their potential liabilities. We understand the impact that reserves have on our client’s ability to assess their actual exposure. We stress reserve “accuracy”, rather than “adequacy”, as we recognize that reserves that are higher than necessary are as problematic as reserves that are insufficient. (Note: Reserves are always set consistent with our client’s reserving philosophy and approval requirements.) During the initial case evaluation and no later than seven calendar days from the date the claim is originally reported to us, the examiner will establish a reserve that reflects the likely cost of the case based on the available factual and medical information. Subsequent reserve changes are made within seven calendar days of receipt of any additional information. It is our philosophy to ensure that the reserves represent the probable ultimate outcome based on available information.

Our clients can set thresholds for reserve authority and reporting. When the designated level of client authority is exceeded, the Claims Examiner will consult the client and/or submit the recommendation for approval.

Claim reserves will be reviewed by the examiner no less frequently than at each Case Resolution Diary (every 45 – to 60 days, depending on client requirements), and with the client at each claim review.

Reserve changes must all include documentation as to the reason for the reserve change, and a detailed assessment of the exposures. Examiners will utilize Origami’s built-in Reserve Change Worksheet unless the client has developed and designated the use of an alternate worksheet. In those cases, the use of an alternate worksheet will be documented in our Client Special Claims Handling Guidelines.

Diary System LWP places a great deal of emphasis on diary management, utilizing our aggressive dual-track diary system. Our system combines aggressive action-based diaries with an ongoing focus on case resolution.

Beginning immediately after the three-point contact, the Examiner sets action diaries as well as a Case Resolution Diary.

Building strong relationships enables better treatment outcomes, earlier return to work and lower litigation rates - all critical factors in reducing the ultimate cost of claims. We achieve these results by integrating relationship building blocks for our adjusters directly within the claims management system. This integrated and directed focus creates timely and appropriate interactions with our clients, injured employees, physicians, and claim service providers.

Action Diaries- By building action triggers, focused on specific activities, the examiner ensures that time is not wasted, and the claim continues to move toward resolution. The examiner will set the action diary for the next milestone that is expected (ie. medical appointment, hearing, etc.). The examiner will reach out immediately following that appointment to ensure it went forward, and to obtain a verbal status on which the examiner can plan the next action.

Case Resolution Diaries- In addition to these action triggers, at intervals no longer than 60 days, the Examiner updates the Case Resolution plan to ensure that we are focused on resolving all issues to close the claim as quickly as possible.

We remained focused on the final outcome and are always looking for creative ways to resolve a claim as quickly as possible. We always start with the end in mind!
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Our diary system is also used to route work between examiners and support staff, supervisors and managers. By using an automated diary system, we are able to strictly adhere to the tight statutory guidelines involved in the management of Workers’ Compensation claims. Management dashboards are updated in real time to alert Supervisors to overdue diaries. By utilizing these alerts and reports, claims supervisors can take corrective action whenever examiners or support team members have not completed an assigned task in a timely manner.

Automated Diary System
LWP’s claim diary system has some built-in diary functions that add levels of safeguard to the claims management process. Those features include:
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System does not allow a claim to be open without at least one diary System creates auto diaries to supervisors and managers when reserves are inadequate to make payments System creates auto diaries to supervisor and manager when reserve worksheet is created that exceeds examiners’ authority (reserves will not post until someone with sufficient authority approves) Diary history is maintained permanently in our claims system as an audit trail.

Documenting Case Strategy (Plan of Action) LWP utilizes an action-based claims management system to focus efforts on the RIGHT actions at the RIGHT time. It incorporates our proprietary plan of action format with an aggressive action based diary system. The plan of action format prompts the examiner to address each claim issue (ie. compensability, medical management, disability management, subrogation, etc.), outline pertinent factors and document the actions taken to resolve the issue. The diary system allows the examiner to look at the claim as often as necessary and outlines a recommended frequency for each action item.

Each time the plan of action is updated, or the diary is worked, the claim notepad is automatically updated to retain a complete record of all changes and updates. To balance the level of flexibility the examiners have, each claim is required to have an initial all-encompassing plan for case resolution within 30 days of the initial report to LWP. The overall case resolution strategy is required to be updated no less frequently than every 60 days to ensure a continued focus on claim resolution.

That plan of action can easily be viewed online by a client, or can be printed and provided as the basis for telephonic or face-to-face claim reviews.

Disability Management At LWP, disability management is the most critical component in reducing workers’ compensation costs.

When there is lost time, the treating physician will be contacted no less frequently than every two weeks to verify the current medical status. During those calls, we attempt to coordinate full duty, or modified return to work by pressing the treating physician for the abilities of the injured employee. Our examiners are trained to probe for information about what an employee is ABLE to do, rather than accepting “unable to return to work” as a status.

Examiners maintain an ongoing dialog with our clients about their Return-to-Work programs. It is the responsibility of the examiner to educate the treating physician about the employer’s temporary modified duty program and to press the physician to consider the Injured Workers’ abilities, including their activities of daily living. The examiner will remind the physician that the ability to climb stairs at home (as an example) is no different from the ability to climb stairs at work.

Upon receipt of modified or full duty release, the employer contact, the local supervisor/manager, and the employee will be contacted to facilitate return to work. All efforts are documented in our electronic claim notes.

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We work with appropriate vendors to assist in facilitating return to work. Possible steps include (not necessarily in this order):
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Diagnostic testing to determine objective findings
Telephonic or field nurse case management
Second opinions
Referral to a specialist
Objection to the treating doctor
Medical Management LWP subscribes to the sports medicine philosophy of medical treatment. We advocate immediate diagnostics and early aggressive treatment to shorten the treatment timetables and keep the injured worker focused on recovery and return to work. We understand that protracted treatment leads to a “disability” mindset and reduces the likelihood of a productive return to work. It also leads to dependence on pain medications and the resulting “disability” syndrome.

Appropriate and timely medical management is the key to ensuring prompt and cost effective case resolution. We start the medical management process prior to receiving any claims, by working with the employer to educate them about the importance of selecting the proper medical providers. We assist the employers in finding and selecting physicians who are committed to providing quality care and understand advanced return to work techniques.

We believe that the most successful claims outcomes are achieved through a multi-pronged approach to Medical Management:
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Upfront selection of physicians who are committed to outcomes-focused care with an understanding of advanced return-to-work techniques
Ongoing dialog with the treating physicians to ensure that physicians remain focused on return-to-work and successful medical outcomes
Cost-effective use of Utilization Review
We continue to evaluate our results and refine our Utilization Review referrals to ensure that we balance the need for accelerating medical care with the need to ensure that unnecessary treatment is prevented or curtailed as quickly as possible.

Once reviewed, the examiner can approve the treatment (if within our protocols) or can fax from the document management system directly to the UR partner. Examiners are encouraged to use the UR services at any time that they have questions or concerns about requested treatment. In the absence of specific concerns, though, our examiners are permitted to approve those services that are consistent with our internal guidelines and any guidelines set by our clients.

UR Guidelines:

Examiners are encouraged to use the UR services at any time that they have questions or concerns about requested treatment. In the absence of specific concerns, though, our Examiners are permitted to approve the following procedures (subject to client’s agreement):
· Diagnostic Tests Including: X-rays, CT Scans, MRI Scans, EMG’s and other tests as deemed appropriate
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16 PT/Chiro visits or less for initial request or exacerbation 16 PT visits post-op
DME $1000 or less
Specialist referral (including ortho, dentist, dermatologist, general surgeon, etc.) Hernia repair surgery
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· Knee and Shoulder arthroscopic outpatient procedures where objective findings are documented on diagnostic test results such as MRI, CT etc.

Non-Opioid Pharmacy requests under $600
Opioids with estimated duration of less than 30-days
Initial requests for steroid injections to joints (NOT ESIs) Ultrasling, Polar Care unit for post-op shoulder
Home Health Care in documented catastrophic losses
Transportation
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Aquatic Therapy
Electromyography (EMG) and nerve conduction velocity (NCV) testing Trigger point injections
Joint steroid injections
Massage therapy
Dental work
Home health care/aides physical therapy/aides
Skilled nursing visits
Nursing home, skilled nursing facility, convalescent or residential care admissions Orthotic device
Because LWP Examiners approve most straightforward treatment requests, our experience has proven that less than 30% of treatment requests that are sent to UR are approved at the nurse level. More than 70% of our referrals are escalated to the physician level and do result in treatment modifications or non-certifications, providing evidence that LWP does not inflate UR costs through unnecessary referrals.

Requests that may warrant a referral to the Utilization Review partner include:
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Physical therapy treatments in excess of 16 visits
Occupational therapy treatments in excess of 16 visits
Hospital Admission (for other than surgeries listed above) In-Patient Surgery (except as listed above)
Outpatient Surgery (except as listed above)
Chiropractic treatments in excess of 16 visits
Pain Management
Acupuncture in excess of 16 visits
Possible Repeat or multiple diagnostic procedures to include magnetic resonance imaging (MRI) and computerized axial tomography (CT scan)
Durable medical equipment greater than $1000
Biofeedback and pain management, initial evaluation and “full” chronic pain management programs
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Weight loss programs
Experimental treatments
Functional Restoration programs
Ongoing opioids, antidepressants, and addictive medications Compound medications
Cost-effective use of Nurse Case Managers
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It is our philosophy to utilize nurses on a case-by-case basis. Field case management is generally reserved for those claims that are more severe or where face-to-face intervention with both the employee and treating doctor will serve to facilitate an early return to work and recovery.

Field case management is assigned on all catastrophic losses to assist us in facilitating prompt and appropriate medical treatment. On these claims, the injured workers have an immediate need for a high-level medical professional to assist with managing and explaining the pending medical treatment. The nurse also acts as a liaison between the injured employee’s family, the employer, and the claims team.

Although an examiner can assign a telephonic Nurse Case Manager at any time, we use their assistance very sparingly.

Situations that might warrant consideration of a nurse referral include:
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The treating physician is reluctant to support return to work efforts The treating physician does not provide the reports we require The injured worker in non-cooperative in return-to-work efforts Medical treatment seems inconsistent with the diagnosis Subjective complaints are not consistent with the physician’s diagnosis Future medical cases with excessive treatment or medication use LWP gives full system access to assigned nurse case managers. This minimizes the time and money spent in shipping information between the Examiner and the nurse case manager. The nurse can enter their notes and case strategy directly into our electronic claim file. This speeds the exchange of information and reduces unnecessary paperwork, reports and expense.

Effective Medical Cost Containment Programs
LWP’s cost containment program, SPHERE Solutions, is flexible and can be adapted to meet the unique needs of each client. We offer a menu of services that are focused on speeding claim closures while reducing claim costs. Each service can be customized for each client. Our current programs include:
. Access to multiple PPO & MPN networks
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Ability to wrap PPO networks for increased cost savings Specialized networks for Prescriptions (including first fill), Durable Medical Goods Diagnostic Procedures and Physical Therapy
. Enhanced expertise, quality, and compliance with utilization review o Utilization Review plan allows examiners to approve initial and straightforward procedures to streamline medical treatment and reduce UR costs for employer o
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Integration of Utilization Review Results into the Bill Review System Increased flexibility to perform & track adjuster UR approvals Paperless solution to allow real time access to all medical information . Superior expertise and results in telephonic & field case management o
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Focus on task assignments to contain costs and focus on high-impact services Specialized field case managers for large claims
Dedicated nurses to facilitate communication with adjuster & client Paperless solution to allow real time access to all medical information Effective bill re-pricing
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LWP’s workflow requires bills to be reviewed and approved for payment prior to referring to bill review. It is our belief that bills should first be approved by the examiner to ensure that the client does not incur bill review charges for bills that we intend to object to. If the bill should legitimately face and objection, there is no reason for our client to incur a bill review charge.

Our integrated LWP/Bill Review protocol is as follows:

1. Bill is received in our Sacramento location (via either email, fax, mail , or upload from a provider’s FTP site)

2. The bill is scanned on date of receipt and indexed within 24 hours.

3. Together with ebills received from our clearinghouse, scanned images are then presented to the Examiner for approval in the Claims system.

4. Approved images are uploaded to a secure FTP site for pick-up by accūrō. Each file has a descriptor that has the number and image ids included.

5. The bill data is entered into bill review system, the system checking against the required data elements and previous bill review history for possible duplication.

6. Once cleared for processing, each line of the provider bill is input for compliance to the fee schedule and sent to audit for accuracy of the coding. It is noteworthy that accūrō does not auto-adjudicate bills. Every bill is reviewed by a human…a trained, certified bill reviewer.

7. When the bill is determined to be correct, it is pended and transmitted to all affiliate networks for possible further contracted network reductions.

8. Once a bill is returned from the Networks, the accūrō bill reviewer finalizes the reductions, processes an EOR and sends a file back to LWP in a daily electronic feed, which is posted to a secure FTP site.

9. Once a bill (with the corresponding EOR) is returned from the bill review software, it automatically uploads to our Check Validation queue, where it must pass through a series of automated and manual checks to verify accuracy and appropriateness. Those checks include a systematic check to ensure the following:
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Bill has been approved by the Examiner
Payment is being made on the correct claim
Provider has valid W9 on file
There are no overlapping or duplicate payments that have been missed by the bill review software (as checked by procedure code, provider and dates of service) Check does not exceed client’s special funds threshold
Client does not have special payment procedures
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Additionally, a Supervisor must release each payment individually if they are caught in the queues based on:
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Claim is in delay or deny status
Claim is coded as a “companion” claim
Claim is coded as “first aid”

10. Once all verifications are completed (some are automated and some require claims experts verify), system will issue a check. EOR will print along with the check.

Supplemental Job Replacement Benefits Management Our aggressive return-to-work measures often eliminate or reduce the need for vocational retraining. When an individual meets the eligibility requirements for supplemental job replacement benefits, the Examiner will work closely with the employer to determine if a permanent modified or alternate position can be made available. Employers are educated in the cost savings realized through alternative work arrangements. We also notify the employers that provision of such a position can protect them from other potential discrimination suits.

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requirements and limits of the benefit with the injured employee. The examiner will monitor the distribution of the benefit funds closely to ensure payments are made in compliance with the regulations. The intent is to provide the Injured Employee with the tools to assist with returning to suitable, gainful employment.

Litigation Management We pride ourselves in our very low litigation rate. We believe, and have proven, that prompt and appropriate file handling reduces the number of claims that go into litigation. When an Iinjured worker chooses to be represented, we are generally able to work with the applicant’s attorney to resolve the case without the intervention of a defense attorney. Our examiners are trained and routinely handle legal hearings on behalf of the employer. When a need arises to obtain the services of a defense attorney, the claims examiner must request approval from their supervisor to ensure that the litigation referral is appropriate.

At the time of the litigation referral, the examiner must clearly communicate the case issues, the requested services and what our expectations are for the outcome of the case. We work with our attorneys to ensure that claims adjusting functions continue to be performed by the examiner, and that the examiner makes the final decisions on all aspects of the case. Medical control will not be relinquished to defense counsel.

When the case is assigned to counsel, the defense attorney will attend all hearings. We encourage the client to attend as many proceedings as possible to ensure that the desired outcome is achieved.

LWP maintains an extensive litigation program that outlines our Best Practices for both our examiners and panel firms.

It also contains information on how we track and monitor the results of each firm. Our Litigation Management Program is available for review, upon request.

Many of our clients select their preferred attorneys. We are happy to work with the attorneys chosen by the client, so long as they are approved by the clients’ carrier.

We also maintain a panel of attorneys we are comfortable recommending. They have been vetted by our management, and are in compliance with our stringent performance and reporting standards. LWP does not approve firms, but rather approves specific attorneys within specific firms. Those firms are not authorized to utilize other attorneys in their firm without the express permission of LWP and our client. We will provide our panel as input to the client and will meet with the client upon contract award to discuss preferred defense counsel. We will document the client’s preferences in their customized special claims handling guidelines to be used by the examiners in the management of that client’s claims.

LWP maintains Litigation Best Practices, which are available upon request.

Special Investigations (SIU) Our staff receives regular training in how to identify potential fraud without becoming suspicious of honest and well-meaning injured workers. We do not paint all injured workers with a broad brush. But at the same time, LWP takes workers’ compensation fraud seriously. We utilize a list of Key Fraud Indicators that assist the examiner in identifying claims that may require additional investigation. Whenever red flags are identified, the examiner will immediately contact the employer to discuss and agree on an appropriate plan of action. In addition to the mandatory referral list, the examiner may refer any case, at any time, where information arises that raises question to validity of the injury and/or claim for benefits.

Many of our clients look to LWP’s SIU to identify and manage prosecution of fraud. LWP has formed a strategic partnership with an experienced investigation firm to facilitate our Special Investigations Unit (SIU). In the event an examiner finds suspicious activity by any party to a workers’ compensation claim, the SIU Coordinator is contacted to discuss the issues, provide advice and assist the examiner with determining what further action is warranted. The claims examiner, the investigator and the employer will work together to determine the appropriate plan of action.

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For clients who have their own designated SIU, we will work with their SIU to report and prosecute fraught. Regardless of the SIU partner utilized, we will work vigorously to resist and prosecute fraud.

Upon receipt of a referral, the SIU Coordinator reviews the case in its entirety to determine if the case warrants referral to the Department of Insurance, District Attorney’s Office or other controlling regulatory agency. If so, the designated SIU Coordinator completes and submits the appropriate filing and makes the necessary follow up until the issue has been resolved.

The SIU Coordinator may give the claims examiner additional direction to assist in ruling in or out the suspected fraud.

This direction may include but is not limited to ordering recorded statements, film, records and/or a deposition.

Methods for recognizing suspected fraud vary, but often include: information that comes from an employer source that suggests an employee is working and collecting temporary disability or has an activity level outside their working restrictions; medical complaints do not fit mechanics of injury, physical exam and/or diagnostic testing are not consistent; lack of employee availability by phone when the employee is off work and receiving compensation benefits; indication by the treating doctor that the employee is malingering.

On occasion, the SIU investigation raises issues that do not rise to the level of prosecutable but could result in expedited return-to-work. Often, films can be shown to a treating physician that will result in the physician releasing the injured worker to return to modified or full duty. Films that show some moderate activity can be very successfully used to prompt a release even if they are not sufficient for an SIU prosecution.

The SIU Coordinator maintains a log of the SIU referrals, which is provided to LWP senior managers monthly. If we are successful in our efforts and an arrest is made, the client will be involved in the litigation proceedings surrounding the fraud charge to include, but not limited to, plea bargains, orders for restitution, etc.

Large Loss Handling A Large Loss is defined as any new claim that meets the following criteria or develops into one or more of the following conditions:
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Amputation of any extremity
Any injury requiring an in-patient hospital stay
Any injury requiring emergency surgery
Any injury involving transport to medical treatment by ambulance or life flight Any occurrence that results in serious injury to two or more employees Brain Injuries
Fatalities
Heart Attack or Stroke Claims
Life Threatening / Altering Spinal Cord Injuries
Paraplegics / Quadriplegics
Rape / Sexual Assault
RSD
Serious Burns
Violent Crimes
Note: Any client’s definitions of “Large Loss” will supersede LWP’s definitions for that client, and will be documented in our Special Claims Handling database.

Immediately upon receipt of a potential large loss, or the recognition that an existing loss has developed large loss characteristics, the following procedures are followed:

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Upon receipt of a new loss meeting the large loss reporting requirements, LWP’s new loss coordinator will send an email alert to the claims examiner, claims supervisor, claims manager and vice president in a format outlined in our Large Loss Program.

Immediately, but no later than one hour after receiving notice of a large loss (whether by phone, fax, email, etc.), the claims examiner will alert the local claims manager that a large loss has occurred by personal notification or cell phone if the claims manager is out of the office. The claims examiner will also alert their direct supervisor.

Examiner shall set a follow up large loss diary to ensure continued reporting to applicable parties in accordance with any client/excess carrier guidelines.
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 The Claims Examiner retains ultimate responsibility for timely reporting of the loss to their supervisor or manager consistent with our procedures, regardless of any notifications sent out by the new loss coordinator.

Subrogation The claims examiner is responsible for pursuing subrogation, following the process from start to finish.

The client is encouraged to participate in directing claim activity if more intensive investigation or legal representation is needed to pursue a claim for subrogation.

Annual training is provided to claims staff to reinforce the types of claims and circumstances that are likely to have subrogation potential such as premises (i.e. slip-and-fall injuries), auto accidents and equipment malfunctions.

Additionally, our proprietary claims system includes a checklist of potential subrogation triggers to prompt the Examiner to further investigate subrogation potential.

At time of investigation, the examiner will document the investigation and subrogation potential in their Plan of Action.

Unless instructed otherwise, LWP will consult with the client on all subrogation cases to ensure that we have a proper understanding of relationships that may pertain to the subrogation claim so that we can aggressively pursue subrogation when appropriate, but do not unintentionally interfere with our clients’ relationships with their suppliers, vendors, partners, customers and landlords. For cases where a carrier is involved, the examiner will review the insurance contract to determine whether there are any relevant contract terms, including waivers of subrogation.

We will file complaints when necessary and will also work with counsel when appropriate. LWP will not incur investigation or legal costs without the approval of our client.

We will present our evaluation of the cost/benefit of pursuit as well, to clients. Clients will be involved every step of the way. Once subrogation funds have been received, they will be posted to the claim file as a recovery transaction and deposited back into the loss fund account.

Excess Recovery LWP will pursue and recover excess funds in accordance with our client’s excess coverage requirements. Notes about the progress of recoveries will be documented in the electronic claim notes and plan of action, which are available for client viewing through on-line access. Progress will also be presented and discussed with the client at the quarterly claim review.

Settlement Evaluation LWP’s approach to case settlement varies depending on the needs of our clients. While some clients prefer to attempt a Compromise and Release on every claim to eliminate their “tail exposure”, other clients only like to engage in a Compromise and Release negotiation when the employee is no longer employed and/or insured by the client. The settlement approach is something that should be discussed at the initial client orientation to ensure that our approach to settlements is consistent with our client’s program objectives.

When the claim reaches a point where we can begin settlement discussions, the examiner will complete a settlement evaluation worksheet. This worksheet outlines basic claim information, the claim exposure and contains the examiner’s LWP Claims Solutions – updated March 2023 Page 16

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recommendation for the appropriate settlement vehicle and amount. This evaluation will be based on the exposure, as outlined by the treating physician, panel physician and any other admissible medical evidence.

Examiners’ settlement authority is extended based upon the examiner’s level of experience and current performance.

In addition to internal settlement authority protocols, we follow any client settlement authority procedures as defined by our clients. The client may set settlement authority at a designated dollar threshold.

If the settlement range outlined is within the examiner’s internal and client settlement authority, negotiations will begin. If the settlement is over the examiner’s internal and/or external authority, the settlement worksheet will be routed to the supervisor, manager or senior manager (depending on the amount of the settlement) for review and approval. Once approved, the settlement recommendation and supporting documentation is provided to the client or carrier for external approval prior to settlement negotiation.

The settlement recommendation request will include the rationale supporting the request and the projected ultimate value of the claim. Upon submission of the settlement recommendation request, LWP will provide a copy of the current plan of action which includes information on each claim issue, the amount paid to date and the outstanding reserve value. LWP will obtain Medicare Set Aside information when appropriate.

Each claim needs to be evaluated on its own merits. As such, there is no standard method to determine which claims are settled and which are taken to trial. If there is a particular claim where we feel the evidence weighs strongly in the favor of the client, we will discuss with the client our recommendation to take the case to trial. Further, if there is a case that the client feels very strongly about and wants to proceed to trial, we will lay out the pros and cons of the case for the client and provide the client with our recommendation. We often suggest a conference call to include LWP, defense counsel and the client to discuss the issues and ensure that the client has sufficient information to make an informed decision. At LWP though, the decision ALWAYS rests with the client.

Walk Through Settlement Approvals LWP has agreements with several hearing representatives and law firms who will walk settlements through the Appeals Board. This service is unrelated to any defense work, and is utilized frequently, many times for cases that that had not previously involved a defense attorney. For a nominal fee, they hand deliver settlement documents to a judge and wait for the approval. In addition to speeding up approval, this frequently serves the purpose of allowing the judge to have any questions answered instantly, rather than delaying the approval for months by setting an adequacy hearing.

Timely Claim Closure At LWP, we start with the end in mind. All activities on the claim file are designed to move the claim to closure, as quickly as possible. We use our action-based diary system to ensure that the case resolution is updated no less frequently than every sixty days. Regular claim reviews and examiner file strategy updates ensure that we are continually focused on moving a claim to closure and/or resolution as quickly as possible.

Once the file is ready for closure, the examiner completes a closing checklist to document that all statutory guidelines have been met. The closing checklist is then reviewed and approved by the Supervisor before the closure is processed. LWP closes files within thirty (30) days after all issues have been resolved, and/or pursuant to client instructions.

Claims Processing
Claims Intake Immediately upon receipt of a DWC 1 and/or 5020, new reports are indexed in our system to determine if there is an existing claim. If there is an existing claim, the new information is presented to the examiner LWP Claims Solutions – updated March 2023 Page 17

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both as a new diary, and as a new document in our paperless system for handling. If there is no claim in our system, the new claim set up team will look for a policy.

If a relevant policy is located, the “incident” will be entered into the system or attached to the policy if already entered into the system directly by our client.

If no policy is found, the new loss set up team will contact the client to determine whether a policy exists. If so, they can manually enter the policy into our system and then enter the “incident” and attach it to that policy.

Once the “incident” is in our system, it is reviewed by a claims supervisor, who will convert the “incident” to a “claim”, assign the claim to the appropriate examiner and provide detailed direction to the examiner, identifying any issues of note.

Once assigned, the system automatically sends the examiner a diary when a new loss has been assigned, so that three- point contact and initial investigation can commence immediately.

The claims system will also send an email to the designated client contact to notify the client that the claim has been set up as well as providing the claim number and examiner’s name and contact information.

Processing Mail All mail is scanned and electronically date stamped on the date it is received. Mail is indexed overnight and attached to the appropriate claim. That mail is then available for review within the claim file, and also in the examiner’s document inbox with a “needs review” flag. The examiner must act on the mail by the date benefits are due, or within seven 7 calendar days from the date the mail was originally received by the office, whichever comes first.

Medical treatment requests must be handled within one business days from the date the mail was originally received in the office. Mail is handled as follows:
 If the mail triggers the need for a benefit payment, the examiner makes a determination on which benefits are due and orders those to be paid on or before the statutory due date.  If the mail triggers the need for medical treatment approval, the Examiner approves the medical treatment or refers the treatment request to Utilization Review (consistent with internal procedures) within one – two days from the date the mail was originally received in our office.  Medical and/or vendor bills are reviewed to ensure that the service is appropriate for the claim. Approved medical bills are routed to our bill review partner for fee schedule and/or PPO reductions. Other partner bills are routed for direct payment upon approval. If the Examiner disputes the bill, an objection letter is issued directly from our claims system.

All mail is reviewed carefully. As each piece of mail is worked the “needs review” flag is cleared and a note is entered to support the action taken by the examiner on the individual piece of mail.

Payment of bills LWP, in partnership with select partners, offers access to some of the largest Preferred Provider Organizations (PPO) nationwide. In addition to reviewing each medical bill pursuant to the fee schedule set forth by the Administrative Director, LWP will take advantage of all applicable PPO discounts so that the client achieves the best possible cost savings.

Once the examiner has approved the medical bill and/or vendor bill and any appropriate discounts are applied, the payment is processed. LWP utilizes an automated bill payment engine to complete various checks to ensure payment accuracy including checking for duplicates and verifying the provider’s 1099 is on file.

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All bills are paid within 30 days from the date they are received, if not sooner. Prompt payment of medical and ancillary bills creates a smooth relationship with the provider, reduces the paperwork involved with second billing and eliminates the need for follow-up payment calls.

Calculating Disability Payments Upon receipt of each claim file, the claims examiner calculates an initial average weekly wage and temporary disability rate by utilizing the information supplied by the employer on the First Report of Injury. In the absence of receiving said information, we contact the employer to gather information to calculate wages.

Within 10 days of claim receipt, we will request a wage statement from the employer. Once returned to us, the wage statement is calculated and benefits adjusted, if warranted, within fourteen days.

State law requires that the initial payment be made within fourteen days from the date of first disability (with medical certification) and knowledge of injury. As such, our payment is made within the statutory timelines. Subsequent payments must be paid every two weeks, on a designated day, as required by law.

All ongoing disability payments are made based upon supported and documented medical information contained in the file.

The appropriate benefit notices will be sent, always containing all state-required language.

To ensure timely payment to injured employees and service providers, LWP has emergency back up procedures in place in the event of a disaster or system failure at the local claim office level. This also ensures compliance with state requirements to make disability payments on time and avoids penalty exposure.

Penalty Payments LWP is diligent about meeting all statutory time frames to avoid penalties. When penalties are incurred, LWP self-imposes and takes financial responsibility for any penalties caused solely by our handling. We have detailed workflows to ensure proper determination of penalty exposure, and promptly notify the client of the penalty, and its cause. Clients are notified in writing within 30 days of any penalty paid, (or overpayment that should be reimbursed) along with a detailed explanation of the cause as well as the steps taken to prevent future penalties.

Should a penalty arise that is the result of a delay by the carrier, employer or prior administrator, LWP will provide the client with detailed information that can allow the client to hold the proper party accountable. LWP will prepare documentation needed by the client, should they choose to send to the carrier or prior administrator for reimbursement.

Banking
Loss Funding Loss and expense payments are issued from an account set up to meet the specific requirements of each client. The client may select the bank, or LWP will recommend one. We then work with the client to determine a mutually agreed funding amount. Generally, this is 1.5 the anticipated monthly loss payments. As the program develops, we will work with the client to fine tune the deposit thresholds, based upon claims and payment volume as well as the special funds limit the client would like to set for individual payment funding.

Requests for replenishment will be sent via e-mail and will include a check register and invoice. Requests will be made at the close of each month provided the account has sufficient funds. Deposits for replenishment can be made by ACH, wire, or over the counter by our banking team.

Positive Pay LWP encourages clients to select a bank that will allow for a “Positive Pay” feed. On request, LWP will feed payment information to a bank’s secure on-line system to accommodate “Positive Pay”. “Positive Pay” is a service LWP Claims Solutions – updated March 2023 Page 19

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to prevent fraudulent items from being paid against a client's account. It works in conjunction with daily reconcilement by looking at the account daily to verify that in-clearing items match the items issued by LWP.

These systems allow a client to:
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Identify unauthorized transactions–including counterfeit or altered checks before final payment.

Improve knowledge of balances and funding requirements by knowing all checks being paid every day.

Reduce the risk of over-the-counter encashment of unauthorized items.

Gain complete, customized control over the check disbursement process.

Banking Security Some of the security procedures are:
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Only authorized supervisors and/or managers can sign checks Checks over a designated amount (set by client) receive a second signature Security paper is utilized for check stock
System authorities are set to ensure that no person can enter, approve and print checks Bank Account Reconciliation We reconcile each bank account monthly. We will provide a copy of the check register, the bank statement, and a reconciliation report. Bank reconciliation will be completed and delivered within 30 days of the close of each month.

Escheat Quarterly, we will identify stale dated checks. Each un-cashed payment (older than six months) will be audited to determine appropriate follow-up (i.e. should the check be voided and/or reissued). If the payee cannot be located, the carrier will be notified so that proper Escheat protocols can be followed.

Systems
Overview The information systems at LWP are designed to accomplish 6 main missions:
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Provide examiners uninterrupted use of the claim system (except during bi-monthly weekend updates) Provide customers with secure claim and loss reporting
Provide Internet enabled first report of injury (FROI) reporting for employers Provide risk bearing customers periodic feeds of claim and loss information Provide electronic data inputs (EDI) to states, as required Provide IT support for LWP operations
In addition, we develop and support any special use software required to support LWP operations such as import of acquired claims. All claims and reporting systems are developed, maintained and/or overseen by LWP’s IT team.

Claims System LWP utilizes Origami Risk, a modern, browser-based Risk Management Information System for both claims adjusting, document management and for reporting and client interface. Origami is a highly secure, highly configurable system that offers LWP and our clients access to state of the art technology, and secure and flexible reporting capabilities. Because all customization is done through configuration, Origami can deliver a full complement of enhancements every eight weeks that are automatically incorporated into LWP’s platform without any need for custom development. Our ability to respond quickly to customer needs is something that we pride ourselves on and Origami Risk is an intuitive, configurable platform that allows us to retain that focus.

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Origami allows customized data fields and can accommodate any reporting structure. It offers full compliance with all federal and state reporting requirements and can interface fully with various managed care software engines. The system has extensive Ad-hoc and standard reporting capabilities.

Document Management LWP has operated in a paperless environment since 2008. Origami Risk’s fully integrated platform allows LWP to manage all claims processes without creating or maintaining any paper whatsoever. We maintain several levels of redundant storage and have built in tracking systems so that documents can always be found and tracked. Our guiding principles in the development of our customized portal were:
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We must be able to account for ALL mail, with nothing ever being lost or permanently deleted Examiners should not do clerical work (including indexing) Mail must be easily identifiable with meaningful labels, rather than document numbers Naming conventions are critical to allow similar items to be sorted and grouped We must be able to manage mail to know what mail has been read and “worked” We must have management reports available to track mail management Bill approval must be stamped right on the image to validate that the examiner approved the bill PRIOR to sending to bill review
Authority Safeguards- Our claims system (Origami) has several built-in safeguards against errors. First, we have built in authority levels set by examiner that prevent a reserve from being posted without proper authority. The examiner enters their detailed reserve recommendation in our Reserve Worksheet screen. If the Examiner has sufficient system authority, the reserve will post. In cases where the recommendation exceeds the authority level, the claim system will automatically set a diary to the supervisor, manager, or vice president, depending on the value of the recommended reserve. If approved, the reserve will post. If denied, the worksheet will be automatically returned to the examiner for revision.

Similarly, payments cannot be released without reserves. The person entering the payment can complete the entry regardless of the reserve value; however, the check will not print. The system will set a diary for the payment request to a supervisor and post the potential payment onto a report that is cleared daily by the supervisors. The managers and vice president review this report regularly to ensure all payments are released timely. This also ensures that payments are not ignored, lost or misplaced.

Comprehensive Bill Processing Engine
LWP has built a detailed bill processing engine that performs extensive checking before bills are paid. Once a bill is approved, it is either automatically uploaded to the appropriate bill review software, or routed to our Straight Pay engine, if the bill is not eligible for bill review (i.e. legal, UR bill, Interpreters bill, etc.) For bills that are subject to bill review, our IT staff tracks each bill based on a document tracking number assigned at the time of initial receipt. That bill can then be tracked throughout the system and can be searched in the bill review software if necessary.

Once a bill is returned from the bill review software, it is automatically uploaded to our check validation queue where it must pass a series of automated and manual checks. Those checks include a systematic check to ensure the following:
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Bill has been approved by the Examiner
Payment is being made on the correct claim
Provider has valid W9 on file
There are no overlapping or duplicate payments (as checked by procedure code, provider and dates of service)
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. Client does not have special payment procedures
Additionally, a supervisor must release each payment individually if they are caught in the queues based on:
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Claim is in delay or deny status
Claim is coded as a “companion” claim
Claim is coded as “first aid”
For straight pay bills, we employ double-blind keying whereby two staff members each key the payment without the ability to see the work of the other keyer. A comparison queue is then worked by a supervisor to resolve any discrepancies thereby insuring accuracy in bill keying.

Access Tools for Clients LWP offers clients access to the Origami system, allowing the client to do the following:
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Report claims to LWP online
View a customized dashboard with metrics relevant to the client View individual claims details (including financials and adjuster notes) Run reports
On Line Loss Reporting: Clients can use Origami’s secure reporting tool to report claims directly to LWP. It is pre- populated with each client’s contact information and organizational structure. Designated staff can then log in to this secure system. Once a claim is created the client will receive an automated acknowledgement that includes the assigned adjuster and claim number along with the Employers First Report of injury form. Clients can print the reports for recordkeeping and can access a history file within the application to review previously completed reports. Training for this system is provided.

Client Reporting: LWP maintains very robust reporting capabilities. We deliver reports via several methods:
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Regularly scheduled reports are emailed to clients
Client access to templates
Ad-Hoc Reporting for clients
Customized reports prepared by LWP staff
Stewardship reports
Scheduled Reports: Reports available via internet include:
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Cumulative Loss Runs (can be provided at any organizational level) Fiscal Period Report (including detailed financial transactions, reserves, payments and recoveries during a stated period of time. It can be run with detail, or summarized) Closed Claim Log
Standard Claims Summary (financial and data summary of each claim) Payment type reports
Injury Type Reports (Cause, Site, Nature of Injury, Occupation) Lag Time Reporting (date of loss/date of report)
Losses reported by tenure with Company
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OSHA 300 and 300A
Medical Bill Review Savings
Check Registers
Individual Claim Reports (Notes, reserve activity, plan of action, etc.) Standard reports templates allow user to specify:
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Filters (i.e. open vs. closed, claim type, incurred thresholds, parts of body, types of injury, date ranges, etc.) Organizational and timeframes (i.e. reports can be run by division and/or department, and for any contract period and fiscal period)
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. “Value as of” capability
Customized reports prepared by LWP staff: LWP maintains staff with expertise in creating customized reports. The client will have unlimited access to our staff and can request ad-hoc or customized reports at any time. We employ a full-time analyst with very advanced capabilities in order to assist clients with advanced reporting and analysis needs.

Stewardship Report: LWP has developed a package of risk management reports that includes high-level and detailed information in both data and graphical format. These reports will be provided at claim reviews in order to provide an overview of trends and results. Additionally, LWP can commit to creating reports that are needed for any risk management meetings.

Ad Hoc Reports
Clients also have access to Origami’s Ad Hoc report tool which allows for real ad hoc creation of spreadsheets containing any of more than 100 data elements. Spreadsheets can be sorted, formatted and manipulated to allow maximum access to client data. Data from a prior administrator is made available for all clients’ whose prior claims we assume. Data quality is subject to the quality and availability of the data provided by the prior administrator.

Data Management and Feeds Data Management: LWP was an early adopter of the SAS 70 review proves, having completed a review every year since 2004. Numerous financial controls are listed in that document and are independently audited annually.

Among the many actions we take to ensure quality and financial integrity are:
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Adjuster approval of all bills prior to payment or bill review with extensive audit trails Extensive management reports on system access, roles, and authorities Automated data integrity checks in both medical and straight pay Double-blind keying of straight pay bills
Payment checks on medical bills
Vendor W-9 setup by two individuals with no ability to make payments Validation of tax ids against the IRS database
All client data feeds are cross checked against loss runs at specified time intervals Security
LWP takes many actions to prevent data breaches and maintain information security. Among these are:
. Maintaining secure, separate sub-nets via our firewalls that restrict of who can access our systems as part of our perimeter defense against data breaches
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Intrusion detection
Anti-virus and malware software on all machines
Laptop access is restricted to those individuals authorized by CEO We have deliberately not allowed for single sign-on into our systems, but instead maintain separate logins for the firewall (VPN), network and claim system
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Ensuring that all remote access is logged and occurs only over secure connections Removal of all SSN’s from standard and ad-hoc reports
Encryption of all data feeds and transmittal via a secure mode (sFTP) Enforcement of password complexity and change policies
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. Restrictions on who can set up accounts and requirements about documentation of approval for access and authorization
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Encryption of claims data and documents in storage
All servers maintained in a secure Teleco data center
Data center access limited to four pre-screened individuals Restrictions on what software can be loaded on corporate machines Periodic audit of access and access attempts
Data Feeds- LWP provides periodic custom data extracts or “feeds” to our clients in a variety of formats. Data feeds can access data directly from Origami, or can be programmed from LWP’s proprietary data warehouse, depending on the client’s needs. Our IT team’s extensive experience allows them to quickly develop new feeds while also updating existing feeds as our clients update their specifications.

These feeds can be scheduled and run at the client’s preferred frequency. The feeds are always balanced to an independent loss run from our claims system. The feeds can be encrypted and are securely transmitted in the method preferred by the client.
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Litigation Best Practices
LWP Claims Solutions is committed to providing high quality claims services in a manner that is both cost effective and meets the unique needs of our customers. To achieve this objective our examiner’s primary responsibility is the appropriate management of claims costs. A key component of managing our claims costs is the approach we take managing litigation. The following pages will outline our philosophy and recommendations on how to approach litigation. Adherence to these best practices will positively impact each of our client’s allocated expense payments and loss costs.

Table of Contents
LWP Litigation Philosophy............................................................................................ 2 When to Refer to an Attorney...................................................................................... 2 Attorney Selection........................................................................................................ 2 Referral Process............................................................................................................ 2 Expectations of Examiners ........................................................................................... 3 Expectation of Defense Counsel................................................................................... 5 Approved Service Providers ......................................................................................... 9

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Litigation Best Practices
LWP Litigation Philosophy
LWPs philosophy is to:
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employ aggressive proactive case management on every loss to achieve optimum outcomes. control the litigation of the claim from notice of representation through resolution. create and maintain a panel of the best attorneys
limit the scope of tasks assigned to defense counsel to those that require legal credentials and are likely to deliver results for the client.

When to Refer an Attorney
Legal referrals should take place when it is determined that legal assistance is required to achieve the best outcome for the client. Many assignments need only be task specific and, as such, when the requested task is completed defense counsel is to report on the completed task and outline additional recommendations for the examiner to consider. Further attorney activity may only be completed upon the documented approval of the examiner.

Common reasons for referral:
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Attend hearings
Complete depositions
Complex issues that require WCAB intervention
Enforce utilization review determinations
MPN disputes
Subrogation matters
Attorney Selection
When selecting counsel evaluate the following items:
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Firm expertise
Individual attorney qualifications
Geographic location
Client’s Master Handling Guidelines
Prior experience with attorney
Referral Process
The LWP Legal Referral Form (or a client approved equivalent) will be completed and submitted with all pertinent file documentation.

The referral form will specifically outline the reason(s) for the referral, approved activity for counsel to complete and anticipated time periods for the action items to be completed. Specific items to include with the referral are as follows:
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Adjuster Notes
Correspondence
Investigation Reports
Medical Records
Payment details and totals
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Litigation Best Practices
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Personnel File
Wage History
Expectations of Adjusters
General:

The claims examiner is ultimately responsible for the claim and will maintain control of the case.

Litigation budgets must be obtained from counsel per Company standard and documented in the plan of action. Budgets should be updated as the scope of litigation changes, to support the claims examiner’s requirement to maintain accurate reserves.

The claims examiner remains responsible for scheduling medical appointments, ensuring a quality cover letter is sent, subpoenaing records, analyzing, and forwarding records to the attorney, filing and serving medical reports, resolving liens, negotiating settlement and handling other claim issues as they arise.

The examiner is required to document approval or denial of any legal activity that exceeds the scope of the initial assignment.

The examiner is to maintain and document active communication with defense counsel, ensuring the attorney is continually updated with any changes that may affect case resolution.

The examiner will consult with defense counsel when making decisions regarding denial or termination of benefits. Ultimate authority for making the decision rests with the examiner, in consultation with the client.

The examiner will copy defense and applicant counsel on all benefit notices.

The examiner is responsible for adherence to LWP internal settlement authority procedures and adherence to all relevant client-handling requirements.

The examiner is responsible for ensuring that email communication, phone communication, and hard copy correspondence is properly documented in the Origami notepad.

Hearing Notifications:

The file will reflect timely assignment to defense counsel for the management of all hearings.

Upon notice of a hearing the examiner will immediately confirm that defense counsel, employer, and carrier (if appropriate) are notified of the hearing. The examiner will set a diary to complete a full legal work up of the claim and outline actions that need to be taken prior to the hearing date. This review is to occur within 2-weeks of receipt of the notice of hearing, unless already completed.

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The examiner should ensure they are available on the date of the hearing, ready with the appropriate settlement authority.

Negotiation/Settlement Process:

Whenever possible, the settlement negotiations should be completed by the examiner, providing updates to assigned counsel. The examiner does have the authority to delegate the negotiation process to assigned counsel when appropriate.

If the defense attorney is given authority to negotiate, they must be provided detailed instructions outlining the expected initial offer amount, the anticipated settlement amount and the limit of settlement authority extended.

The examiner and defense counsel need to work jointly to ensure settlement documents are completed and provided to applicant counsel within 5-days of verbal agreement to a settlement proposal. If the settlement agreement is reached at the WCAB, defense counsel will take all necessary steps to complete the documents and walk the settlement through that day.

Settlement approvals will be expedited as much as possible.

If there is a dispute over compensability and/or special account handling instructions regarding settlement authority, the examiner must consult with the employer and/or carrier. Ideally this should occur before negotiations begin. The consultation will be done prior to completion of any settlement agreement.

Legal Bill Review:

All legal bills will be processed through Origami. The examiner will document the amount of payment being authorized. By review and approval of payment the reviewer is confirming the following items were considered:
. Initial File Review: Compare the complexity and volume of the file in relation to the hours billed for review. Does the file summary report support the time billed? Basic information contained in our cover letter, such as wages, date of injury etc. should not be regurgitated in the defense attorney’s letter.
. Initial Set Up Fee: There is not to be a separate charge for a new referral to “set up” the file. This “fee” should already be worked into the attorney’s overhead. .
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c. Notices: If we are billed, it should be at the paralegal or administrative rate.

File and Serving Documents: The Claims Processional is responsible for filing and serving documents on all parties whenever possible. If it is necessary for defense counsel to do so, the activity should be billed at the paralegal or administrative rate. . Travel Time: Defense counsel will be compensated for appropriate travel time in the local jurisdiction. Where travel outside the local jurisdiction is anticipated, counsel must obtain prior approval before billing. On the rare occasion that airfare LWP Claims Solutions Revised March 2023 Page 4

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Litigation Best Practices
is necessary, only coach fare will be approved. If counsel is appearing on more than one case, pro-rating of travel time is required.
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Deposition Summary: Report from defense counsel should focus only on the relevant issues and should not contain information that is not pertinent to the claim.

Hourly billing rate: To be determined by mutual agreement between the defense attorney and LWP Claims Solutions, not the individual claims professional. Our risk bearing clients have the right to make direct arrangements with defense counsel. .
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Attorney Rate vs. Paralegal/Administrative Rate: When reviewing legal bills from defense counsel, ensure that clerical duties are billed at the lower rate. i. Miscellaneous Expenses: Legal bills must be reviewed carefully for appropriateness prior to approval. If the attorney is given a last-minute assignment, which requires an overnight delivery charge for timely filing of documents, then it is appropriate to bill for the charge. However, if use of an overnight service is required due to backlog in the attorney’s office LWP is not to be billed.
. j. Legal Research: A claims supervisor or claims manager must approve all legal research for which LWP will be billed. There should be no charge for routine legal research, as counsel should be well versed on the law of their particular jurisdiction.

Expectations of Defense Counsel
Initial Review Reporting:

On receipt of file determine the following:
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Verify applicants benefit rate and AWW.

Confirm if MPN rules and regulations apply to the case.

File notice of Representation
Review case assignment details and formulate initial recommendations.

Provide a schedule for completion of assigned activity.

Provide projected budget for completion of assigned tasks.

For the duration of case assignment, updates on developments and changes in settlement value and total monetary exposure.
. Issue a summary report on each significant event. When reporting, discuss all pertinent, unsolved issues and recommended plan of action. (Note- LWP does not want regular monthly reporting. Reports should be generated only upon developments.)
. Comply with required 72- hour turnaround time for assignments such as filing DORs, setting deposition, etc.
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Respond to all phone calls and emails within 24 hours.

Send all correspondence via fax to: (408) 725-0395 or by mail LWP Claims Solutions Revised March 2023 Page 5

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Litigation Best Practices
. Email time sensitive issues and documents to claims examiner and fax to number above, as well.

Deposition Scheduling:
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If no date available within 45 days, set on notice and subpoena the applicant. If no appearance, discuss with claims examiner re: filing Petition to Compel and for sanctions.

If applicant’s attorney requests cancellation or rescheduling, insist on a date earlier than the current setting or allow up to two weeks after current setting. Do not change date without notifying claims examiner.

Obtain a signed Social Security Release from the applicant at all depositions. This is needed to facilitate the obtainment of an MSA if required. .
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Use deposition setting as opportunity to discuss AME if no panel has been issued.

If deposition cannot be completed in one session, obtain all information on past claims, doctors and medical facilities and prior jobs that may be necessary to the litigation. Obtain all records prior to part 2 of the deposition. .
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Set part 2 within thirty days of first part to maintain momentum in case.

Call claims examiner to notify of status and disposition.

Schedule deposition of AME or QME when a supplemental report is requested. If a sufficient supplemental report is received, deposition can then be cancelled.

Medical Legal Evaluation Scheduling:
. Defense counsel should not choose an AME that cannot evaluate applicant within 3 months. If no agreement can be reached on a doctor with appointments in that timeframe, proceed to panel QME.
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Obtain LC §4050 evaluations when appropriate to submit to treater, AME or Panel QME for review.

Defense counsel will provide evaluator with all medical reports and necessary records as well as a job description at the time of the initial evaluation. The cover letter to the evaluator should solicit opinion on potential liens – such as treatment with non-MPN doctors or UR denied treatment. We should avoid supplemental reports when ever possible. Defense counsel is not to use boilerplate cover letters to evaluating or treating doctors.
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Re-evaluation with panel QME or AME should be immediately set on receipt of any report that does not contain a finding of P&S/MMI.

If panel QME or AME requests a consult or diagnostic study, arrange within 20 days of receipt of the report.

WCAB Filings:
. Defense counsel is expected to file any Declaration of Readiness to Proceed on walk through calendar to avoid delay. Call ahead to determine clerk availability to set date immediately.
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Counsel should file all Petitions on walk through calendar.

Whenever possible defense counsel will walk through any settlements without a conference.

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Litigation Best Practices
Applicant treating with non-MPN doctor:
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Object in initial letter to Applicant’s attorney.

If no choice of MPN doctor within 20 days, file DOR for Expedited Hearing. Check for “continuity of care” issues.

Surveillance:
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Defense counsel may recommend surveillance on a claim. Any referral for surveillance must be approved and completed by the examiner.

Surveillance should be scheduled to coincide with known activity such as deposition, medical appointments or work shifts to maximize effectiveness.

Film should be supplied within 20-days to medical evaluators if strategically appropriate for the case. Use of film will always be done on a case-by-case basis.

Supervisor involvement should be solicited if the decision is to withhold film.

Liens:
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Defense counsel is to prepare all exhibits necessary to litigate liens prior to filing a DOR on the case in chief.

All lien claimants or potential lien claimants are to be notified in writing that the lien is in issue at MSC and demand in-person attendance of lien holders at WCAB.

Issue demand for the paper lien and all supporting documents within ten days of MSC.

Authority to resolve all outstanding liens must be obtained prior to attendance at lien conference or trial.

Should lien claimant(s) fail to appear at hearing after being provided proper notice, defense counsel should immediately request a dismissal of the lien or a notice of intent to dismiss from the WCAB.
. Defense counsel should file a lien against the claim to recover any no show fees and costs incurred as a result of claimant actions.

Attending Mandatory Settlement Conference:
. Defense counsel is expected to be prepared for attendance at hearing with updated authority, recent payment history and current payment totals and should not have to obtain this information while at the WCAB.
. Defense counsel is not to agree to go off calendar if our case is ready to proceed unless it is advantageous to our position , and should be in conjunction with examiner approval
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If the case is settled at the hearing and outstanding liens exist, defense counsel is to set lien conference date at the time of MSC.

Defense Counsel will call the claims professional from the hearing to notify about status and disposition and advise of any new developments or unexpected issues.

Counsel is expected to be persistent and find a supervisor or another examiner if they cannot reach the assigned examiner from the hearing.

Never go to an MSC without authority to resolve the case or issue.

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Litigation Best Practices
Settlement:
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Defense counsel is expected to contact claims professional once discovery is complete, discuss value of settlement with recommendations for authority.

Defense counsel is to proactively make a settlement offer to Applicant’s attorney, whether they have issued a demand or not. All settlement offers should be made both verbally and in writing.
. If there is no response from applicant attorney to a settlement offer after ten days, defense counsel is to file a DOR.

Legal Research:

Legal research is a non-billable item. If the claims professional receives a request for research which the handling attorney indicates should be paid off the claim, said request should be forwarded to a claims supervisor or claims manager for approval. Any such proposal from counsel must summarize the issues requiring special research and explain how the research is specific to only this file and outside the standard scope of doing business. Further, a projected cost for the research needs to be provided with the proposal for review and approval.

Case Evaluation:

Defense counsel will demonstrate an evaluation of the cost of litigation versus the current cost of settlement on an ongoing basis. Before proceeding with any litigation activity - such as deposition, med/legal evaluation or trial – defense counsel should discuss the cost/benefit analysis with the claims examiner. The cost/benefit analysis should include an evaluation of the current cost to settle, the maximum claim exposure, the best possible outcome, and the most likely trial outcome. The decision and responsibility for proceeding with any litigation activity over settlement rests with the examiner.

When agreement is reached for a compromise and release on complex cases or those that require an MSA, Structured Settlement or have unique settlement terms a copy of the proposed settlement documents must be provided to the examiner for review prior to being routed for signature.

Bill Generation:
. Initial File Review: Basic information contained in the referral form or cover letter - such as wages, date of injury etc. - should not be regurgitated in the defense counsel’s initial report.
. Initial Set Up Fee: There is not to be a separate charge for a new referral to “set up” the file.
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Notices: Billing for receipt of a hearing notice should be at the secretarial rate.

File and Serving Documents: If it is necessary for defense counsel to do so, the activity should be billed at the secretarial rate.
. Travel Time: Defense counsel will be compensated for appropriate travel time in the local jurisdiction. Where travel outside the local jurisdiction is anticipated, counsel must obtain prior approval before billing. On the rare occasion that airfare LWP Claims Solutions Revised March 2023 Page 8

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Litigation Best Practices
is necessary, only coach fare will be approved. If counsel is appearing on more than one case, pro-rating of travel time is required.
. Deposition Summary: Report from defense counsel should focus only on the relevant issues and should not contain information that is not pertinent to the claim.
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Hourly billing rate: To be determined by mutual agreement between the defense attorney and LWP Claims Solutions, not the individual claims professional.

Overnight Shipping: If the counsel is given a last minute assignment which requires an overnight delivery charge for timely filing of documents, then it is appropriate to bill for the charge. However, if use of an overnight service is required due to backlog in the attorney’s office LWP is not to be billed.

Closure:

Once defense counsel has completed all assigned tasks they are to contact the claims examiner for further direction. At that time counsel should make any recommendations for additional legal activity or ask about file closure. Once directed to close the legal file, attorney is expected to keep the file on hand in case additional legal representation may be required in the future.

Any activity performed after file closure must be approved by claims examiner or billing will not be honored.

Approved Service Providers
Investigations and Sub-Rosa:

Given that the specific requirements of individual clients is varied, it is required that the examiner determine which firm should be utilized for each client. The claims manager will identify the partner to be utilized for each client upon examiner assignment to a client.

Subpoena Records:

Macro Pro is the only LWP approved service provider. Barring any specific client direction to utilize a different service assignments can be made through the following means:

Phone: 1-800-696-2511
Fax: 888-696-2270
On Line: www.macropro.com
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Sample Reporting Package

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Table of Contents
Standard Loss Reports
Cumulative Loss Detail .........................................................................................................3 Cumulative Loss Summary ...................................................................................................4 Claim Log ..............................................................................................................................5 Closed Claim Log...................................................................................................................6 Plan of Action .......................................................................................................................7 Financial Reports
Fiscal year Report Detail.......................................................................................................9 Fiscal Year Report Summary...............................................................................................10 Check Register....................................................................................................................12 Sample Reconciliation ........................................................................................................13 Sample Stewardship and Overview Reports
Option 1.............................................................................................................................14 Option 2.............................................................................................................................22 Option 3.............................................................................................................................31 Option 4.............................................................................................................................37 Reserve Change Summary Report .................................................................................... 38 Period Claim Development Summaries
Open Claims Log ................................................................................................................41 New Claims in Period .........................................................................................................42 Closed Claims in Period..................................................................................................... 43 Work Status Summary ...................................................................................................... 44

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Worker's Compensation Cumulative Loss Analysis
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015
Claim Number Claimant Date of Loss Reported Opened Net Reserves Net Incurred Net Paid Net Outstanding 1708000026 Reynaga, Jorge
DOB: 04/10/1987 (29) DOH: 02/01/2007
Occupation: Plant Manager
IND
LAE
0%
0%
.00
.00
.00
.00
.00
.003/23/2017 3/23/2017 4/6/2018
MED
4850
100%
0%
5,000.00
.00
750.00
.00
4,250.00
.00Account Level 1: Sample Client
Level 2: California Distribution
Level 3: Plant Maintenance
Level 4:

Type: Indemnity
Status: Open (04/06/2018) Total 5,000.00 750.00 4,250.00 Cause: Fall, Slip, or Trip - On
Nature: Strain or Tear
Site: Ankle
Agency: Fall-Different Level/Policy Number: XYZ23567 Policy Period: 01/01/2017 - 12/31/2017 Two EE's were lifting a 50 ft truss causing to feel a pull in his right arm 1708000027 Banner, Robert Bruce IND
LAE
14%
17%
69%
0%
2,500.00
3,000.00
12,500.00
.00

1.00 1.00

1.00 .00
2,499.00
DOB: None () DOH: None 1/4/2017 1/6/2017 5/17/2018 2,999.00 12,499.00
.00
Occupation: Policeman MED
4850Account Level 1: Sample Client Type: Indemnity
Level 2: Police
Level 3: Police
Status: Open (05/17/2018) Total 18,000.00 3.00 17,997.00 Level 4: Cause: Cumulative, NOC
Nature: Strain or Tear
Site: Lower Back Area
Policy Number: XYZ23567
Litigated
Policy Period: 01/01/2017 - 12/31/2017 Agency:

EE is claiming a CT presumptive low back injury
1708000029 Charles, Luke IND
LAE
53%
4%
12,000.00
1,000.00
9,750.00
.00

1.00 1.00

1.00 .00
11,999.00
999.00DOB: None () DOH: None 5/7/2017 5/19/2017 5/17/2018 Occupation: Fireman MED
4850
43%
0%
9,749.00
.00Account Level 1: Sample Client
Level 2: Fire
Type: Indemnity
Status: Open (05/17/2018) Total 22,750.00 3.00 22,747.00 Level 3: Fire
Level 4: Cause: Other, Miscellaneous NOC
Nature: Infection
Site: Lungs
Agency:Policy Number: XYZ23567 Policy Period: 01/01/2017 - 12/31/2017 Exposure to pneumonia
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Worker's Compensation Cumulative Loss Analysis
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015
Employer Summary: Sample Client
Litigated: ***** 6%
Open Closed Total
21 6
Net Reserves Net Incurred
234,694.87
56,619.50
Net Paid Net Outstanding
Indemnity
Medical Only
First Aid
20 6
1 IND
LAE
41%
10%
49%
0%
64,084.81
158.00
170,610.06
56,461.50
267,042.00
2,000.00
Subrogation: ***** 9% 0
0 1
Future Medical: ***** 3% 4 4 MED
4850
280,300.00
2,000.00
13,258.00
.0031 32
Total 573,614.37 77,500.81 496,113.56
Overall Summary: Open Closed Total
21 6
Net Reserves Net Incurred
234,694.87
56,619.50
Net Paid Net Outstanding
Litigated: ***** 6% Indemnity
Medical Only
First Aid
20 6
1 IND
LAE
41%
10%
49%
0%
64,084.81
158.00
170,610.06
56,461.50
267,042.00
2,000.00
Subrogation: ***** 9%
Future Medical: ***** 3%
0 0
1 4 4 MED
4850
280,300.00
2,000.00
13,258.00
.0031 32
Total 573,614.37 77,500.81 496,113.56
6/1/2018 LWP Demo Page 1 of 1

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LWP DEMO Claim Log
Valued as of 05/31/2018
Level 2 Claim Number Claimant Claim Type Status Date Opened Loss Date Close Date Total Incurred Adjuster 1708000013
1708000019
1808000001
1808000004
1808000007
1708000023
1808000008
1808000006
1708000026
TEST
Jacob, John
Jacob, John
Capoli, Joe
Indemnity
First Aid
Open
Open
Open
Open
Open
Open
Open
Open
Open
Closed
Open
Reopened
Open
Open
10/17/2017
12/14/2017
3/29/2018
4/4/2018
4/6/2018
4/4/2018
4/6/2018
4/4/2018
4/6/2018
9/5/2017
4/6/2018
4/4/2018
10/17/2017
12/14/2017
10/3/2017
10/3/2017
2/27/2018
3/23/2018
4/2/2018

0.00 Judy Adlam
Judy Adlam
Judy Adlam
VONNIR Demo
Riley Taylor
Riley Taylor
Riley Taylor
Demo User
Riley Taylor
Double- Blind
Demo User
Demo User
Judy Adlam
Judy Adlam

0.00 California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Operations
California Operations
Indemnity
Indemnity
Indemnity
14,519.96

0.00Day, Windy
Figuerra, Jesus 0.00
Gibbs, Alexandra Indemnity
Raulinaitis, Bailey Indemnity
Raulinaitis, Bailey First Aid
3/27/2017
3/29/2018
3/30/2018
3/23/2017
9/5/2015

0.00 0.00

0.00 Reynaga, Jorge

TEST, TEST
Thinking, Wishful
Thinking, Wishful
1, Test
Indemnity
Indemnity
Medical
5,000.00

50.00 0.00
9/25/2017
1708000024
1808000003
1708000012
1708000020
2/14/2017
3/14/2018
10/6/2017
9/30/2017
Indemnity
Indemnity
First Aid

0.00 31,500.00

0.00Claimant,
Demonstration
California Operations
California Operations
California Operations
California Operations
California Operations
California Operations
California Operations
California Operations
Fire
1708000021
1808000002
1708000011
1808000005
1608000002
1708000016
1808000009
SAC0000076130
1708000029
1708000028
1608000004
1708000027
John, Sample
Pagal, Yolanda
Sample, Test2
Sampled, John
Shelton, Vicki
Test1, Rob
First Aid Open
Open
Open
Open
Open
Open
Open
Reopened
Open
Open
Open
Open
12/14/2017
3/29/2018
10/17/2017
4/4/2018
10/17/2017
3/27/2018
10/11/2017
1/3/2018

0.00 Test LWP Adjuster
Riley TaylorMedical 0.00
Medical 0.00 Judy Adlam
Indemnity
Medical

0.00 VONNIR Demo
Test LWP Adjuster
Judy Adlam
1/8/2018 12/14/2016
10/6/2017
4/6/2018

0.00 Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
11/8/2017
4/6/2018
1,500.00

0.00Valencia, Elvis
Walker, Maggie
Charles, Luke
Maximoff, Pietro
Shade, Victor
Riley Taylor
3/20/2015
5/17/2018
5/17/2018
5/17/2018
5/17/2018
3/19/2015
5/7/2017
186,781.41
22,750.00
119,850.00
31,830.00
18,000.00
ZZ-Demo Examiner
Riley Taylor
Fire 11/21/2016
12/6/2016
1/4/2017
Riley Taylor
Parks Riley Taylor
Police Banner, Robert
Bruce
Riley Taylor
Police 1808000010
1508000003
1808000011
1508000004
1508000002
1708000030
Rogers, Steven Medical Open
Open
Open
Open
Open
Open
5/17/2018
5/17/2018
5/17/2018
5/17/2018
5/17/2018
5/17/2018
1/18/2018
8/25/2015
5/4/2018
13,790.00
14,350.00
15,900.00
70,493.00
17,000.00
10,400.00
Riley Taylor
Riley Taylor
Riley Taylor
Riley Taylor
Riley Taylor
Riley Taylor
Police Romanoff, Natasha Indemnity
Maximoff, Wanda MedicalPublic Works
Public Works
Public Works
Public Works
Grand Totals - 32 Claims
Parker, Peter Indemnity 1/22/2015
7/15/2015
10/18/2017
van Dyne, Janet
Walters, Jennifer Indemnity
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LWP DEMO Closed Claim Log
Valued as of 05/31/2018
Level 1 Level 2 Claim Number Claimant Claim Type Loss Date Close Date Total Incurred Employer: Sample Client
Type Of Claim: First Aid
Sample Client 1708000019
1708000020
1708000021
1808000006
Jacob, John First Aid 10/3/2017
9/30/2017
10/17/2017
3/30/2018

0.00 0.00

0.00 0.00
Sample Client California Operations
California Operations
California Distribution
Claimant, Demonstration First Aid
Sample Client John, Sample First Aid
First AidSample Client Raulinaitis, Bailey
Totals for First Aid - 4 Claims
Type Of Claim: Indemnity
Sample Client Fire 1708000028
1708000029
1508000003
1708000027
1708000013
1808000008
1508000004
1708000030
1608000004
1808000009
1708000026
TEST
Maximoff, Pietro
Charles, Luke
Romanoff, Natasha
Banner, Robert Bruce
Jacob, John
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
Indemnity
11/21/2016
5/7/2017
119,850.00
22,750.00
14,350.00
18,000.00

0.00 Sample Client Fire
Sample Client Police
Police
8/25/2015
1/4/2017Sample Client
Sample Client 10/3/2017
3/29/2018
1/22/2015
10/18/2017
12/6/2016
4/6/2018
Sample Client California Distribution
Public Works
Raulinaitis, Bailey
Parker, Peter

0.00 Sample Client 70,493.00
10,400.00
31,830.00

0.00 Sample Client Public Works Walters, Jennifer
Shade, Victor
Valencia, Elvis
Reynaga, Jorge

TEST, TEST
Sample Client Parks
Sample Client California Operations
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Distribution
California Operations
California Operations
California Operations
California Operations
California Distribution
Sample Client 3/23/2017
9/5/2015
5,000.00

50.00Sample Client 9/25/2017
4/11/2018
Sample Client 1808000001
1808000003
1708000023
1808000004
1808000005
1708000016
SAC0000076130
1708000012
1808000007
Capoli, Joe 2/27/2018
3/14/2018
3/27/2017
3/23/2018
1/3/2018
14,519.96

0.00Sample Client Thinking, Wishful
Gibbs, Alexandra
Day, Windy
Sample Client 0.00
Sample Client 0.00
Sample Client Sampled, John
Test1, Rob

0.00 Sample Client 10/6/2017
3/19/2015
10/6/2017
4/2/2018
1,500.00
186,781.41
31,500.00

0.00 Sample Client Walker, Maggie
1, Test
3/20/2016
Sample Client
Sample Client Figuerra, Jesus
Totals for Indemnity - 21 Claims
Type Of Claim: Medical
Sample Client California Operations
California Operations
California Distribution
California Operations
Police
1708000011
1608000002
1708000024
1808000002
1808000010
Sample, Test2
Shelton, Vicki
Medical
Medical
Medical
Medical
Medical
10/11/2017
12/14/2016
2/14/2017
3/27/2018
1/18/2018

0.00 Sample Client 0.00
Sample Client Thinking, Wishful
Pagal, Yolanda
Rogers, Steven

0.00 Sample Client 0.00
Sample Client 13,790.00
6/1/2018 10:47:47 AM Page 1 of 3

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Workers’ Compensation Cumulative Loss Analysis / Plan of Action Claim Received and Amounts as of 6/1/2018
Demo Program/Carrier
Claimant Name: Parker, Peter
Claim Type: Indemnity
Occupation:

Claim Number: 1508000004
Employment Status:

DOH:

Date of Injury: 1/22/2015
DOB:

Disposition: Accepted
Litigated: No
Age: Life Expectancy: Future Medical:

FINANCIALS
INDEMNITY: 32%
EXPENSE: 16%
MEDICAL: 52%

PAID OUTSTANDING
$22,491.50
$10,999.50
$36,999.00

INCURRED
$22,492.50
$11,000.50
$37,000.00
$1.00
$1.00
$1.00
Level 1: Sample Client
Level 2: Public Works
4850: 0% $0.00 $0.00 $0.00
TOTAL: $3.00 $70,490.00 $70,493.00

PLAN OF ACTION
History:

This claim involves a then-53 year-old employee who sustained injury to his right shoulder while lifting a hydraulic valve out of a box.

Accepted body parts:

Right shoulder
Other active claims:
0000000000 - Left hip & ankle, bilateral knees. Employee remains TTD, but he has hit the cap on benefits and PD is being advanced.
1111111111 - Low back, MMI and advancing PD
2222222222 - Right knee, stipped
Medical:

Employee treats with doctor, last seen 03/28/18, next visit 2-3 visit. The employee underwent shoulder surgery on 02/27/18 in the form of arthroscopic rotator cuff repair and is proceeding with post-op treatment including physical therapy. AME evaluation also took place with doctor 11/13/17, but unfortunately he only addressed the low back injury and none of employee's other injuries. In a recent deposition of AME, AME admitted he didn't perform a physical evaluation.

AME re-evaluation took place 03/16/18 and we are awaiting that report.

Disability:

The employee was TTD for multiple injuries including this one, but since he has hit the 104- week cap on one claim and is MMI for the other, TD benefits being issued off this claim. The employee may hit the 104 week cap on eligibility for benefits in as early as 04/16/18 weeks, but doctor will need to clarify employee's work status for certain periods to determine this. I am following up for clarification on this at this time.

Maximum medical improvement:

Not yet MMI

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

219

Litigation:

A/A applicant attorney, D/A defense attorney. No current litigation.

Investigation:

Not applicable
Excess:
$500k threshold
Subrogation/Apportionment:

Not applicable
Reserves:

Appropriate based on current case facts.

Plan of action:
-
-
-
-
Issue TD benefits. Follow up with doctor to clarify eligibility for prior "not working" periods Obtain AME re-eval report
Continue to manage medical treatment as appropriate.

Confirm employer results of interactive process on low back claim and obtain MMI report for all injuries. Work up all claims for settlement per Compromise and Release.

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

220

Sample Fiscal Year Detail Claim Export Data
Information Provided as a Data List as a Sample of Exportable Fields Policy Period Total Paid Within Defined Period
Employer Name
Level 1
Level 2
Level 3
Level 4
Level 5
First Name
Indemnity Reserve Change Within Defined Period
Medical Reserve Change Within Defined Period
4850 Reserve Change Within Defined Period
Expense Reserve Change Within Defined Period
Total Reserve Change During Defined Period
State in which Accident Occurred
Policy Number
Last Name Claim Number
SS# TPA Knowledge
Loss Date Closed Date
Occupation
Type Of Claim
Impairment Percentage
Carrier
Accepted, Delayed or Denied
Open, Closed, or Re-Opened
Cause
Job Classification
Birth Date
Claimant Address1
Body Part Claimant Address2
Nature Claimant City
User Defined 1 Claimant State
User Defined 2 Claimant Postal
Litigation Type Adjuster User
Subrogation Hire Date
Prior Claim Insuring Company
Safety Violation Adjusting Office
Future Medical Employer Date of Knowledge
Carrier Claim Number
Recovery - Ind/PD/Coll
Recovery - Med/BI/Comp
Recovery - 4850 Differential
Recovery - Expense
Total Paid Indemnity
Total Paid Medical
Total paid 4850
Total Paid Expense
Total Paid Net
Outstanding - Ind/PD/Coll
Outstanding - Med/BI/Comp
Outstanding - 4850 Differential
Outstanding - Expense
Total Outstanding
Incurred Net Recovery - Ind/PD/Coll
Incurred Net Recovery - Med/BI/Comp
Incurred Net Recovery - 4850 Differential
Incurred Net Recovery - Expense
Total Incurred Net
Indemnity Paid Within Defined Period
Medical Paid Within Defined Period
4850 Paid Within Defined Period
Expense Paid Within Defined Period
Total Recovery
Indemnity Recoveries Within Defined Period
Medical Recoveries Within Defined Period
4850 Recoveries Within Defined Period
Expense Recoveries Within Defined Period
Total Recoveries Within Defined Period
Policy Effective Date
Policy Expiration Date
Last Close Date
Current Open, closed, Or Reopened Status
Catastrophe Code
Value as of date for the extract
Date and time this extract run
Carrier Code

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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Fiscal Year Report
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015
Employer: Sample Client
Policy Year Summary: 2015 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred
158,754.91
29,319.50
100,500.00
.00
Net Paid
64,077.81

51.00 Net Outstanding
94,677.10
29,268.50
88,099.00
.00
Reserves
27,492.50
13,350.50
61,000.00
.00
Payments
IND
MO
FA
3 0
0 4
1 0
0 1
4 0
0 5
IND
LAE

1.00 1.00

1.00 .00
MED
4850
Total
12,401.00
.00
288,574.41 76,529.81 212,044.60 101,843.00 3.00
Policy Year Summary: 2016 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred
32,830.00
16,850.00
102,000.00
.00
Net Paid

2.00 Net Outstanding
32,828.00
16,848.00
101,998.00
.00
Reserves
32,830.00
16,850.00
102,000.00
.00
Payments
IND
MO
FA
2 1
0 3
0 0
0 0
2 1
0 3
IND
LAE

2.00 2.00

2.00 .00

2.00 MED
4850
Total

2.00 .00
151,680.00 6.00 151,674.00 151,680.00 6.00
Policy Year Summary: 2017 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred
33,500.00
7,400.00
Net Paid

3.00 Net Outstanding
33,497.00
Reserves
17,000.00
5,400.00
28,750.00
.00
Payments
IND
MO
FA
8 2
0 0
0 0
8 2
IND
LAE

3.00 3.00

3.00 .00

3.00 7,397.00
3 3 MED
4850
Total
46,250.00
2,000.00
753.00
.00
45,497.00
13 13 2,000.00
89,150.00 759.00 88,391.00 51,150.00 9.00
Policy Year Summary: 2018 Amounts-To-Date
Net Paid

2.00 4/30/2018 - 5/31/2018 Transactions
Open Closed Total Net Incurred
9,609.96
3,050.00
31,550.00
.00
Net Outstanding
9,607.96
Reserves
6,090.00
2,050.00
21,550.00
.00
Payments
IND
MO
FA
7 3
0 0
0 0
7 3
IND
LAE

2.00 2.00

2.00 .00
102.00 2,948.00
1 1 MED
4850
Total
102.00 31,448.00
.0011 11 .00
44,209.96 206.00 44,003.96 29,690.00 6.00
6/1/2018 LWP Demo Page 1 of 3

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Fiscal Year Report
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015
Employer Summary: Sample Client Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open
20 6
Closed Total
21 6
Net Incurred
234,694.87
56,619.50
Net Paid
64,084.81
158.00
Net Outstanding
170,610.06
56,461.50
Reserves
83,412.50
37,650.50
213,300.00
.00
Payments
IND
MO
FA
1 0
0 1
IND
LAE

8.00 8.00

8.00 .00
4 4 MED
4850
Total
280,300.00
2,000.00
13,258.00
.00
267,042.00
2,000.0031 32
573,614.37 77,500.81 496,113.56 334,363.00 24.00
6/1/2018 LWP Demo Page 2 of 3

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LWP DEMO Check Register
Transaction Date Check Number Amount Pay to the Order Of Type Claim Number Claimant 5/17/2018
5/17/2018
5/17/2018
5/17/2018
5/17/2018
5/17/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
5/18/2018
1022
1023
1024
1025
1026
1027
1028
1029
1030
1031
1032
1033
1034
1035
1036
1037
1038
1039
1040
1041
1042
1043
1044
1045
1046
1047
1048
1049
1050
1051
1052
1053
1054
1055
1056
1057
1058

1.00 1.00

1.00 Barton, Clinton Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
Payment
1208000004
1208000004
1208000004
1308000003
1308000003
1308000003
1708000029
1408000002
1808000011
1808000010
1708000030
1708000029
1708000027
1708000028
1608000004
1508000004
1408000002
1408000001
1308000002
1708000028
1808000011
1308000002
1508000004
1808000010
1608000004
1708000030
1408000001
1308000002
1708000028
1508000004
1408000002
1408000001
1808000010
1708000029
1608000004
1708000027
1808000011
Barton, Clinton
Barton, Clinton
Barton, Clinton
Lang, Scott

GURVITZ & MARLOWE LLP

THE PERM MED FRP INC STR

GURVITZ & MARLOWE LLP
Lang, Scott Lang, Scott

THE PERM MED FRP INC STR
Charles, Luke
Lang, Scott
Charles, Luke
Danvers, Carol
Maximoff, Wanda
Rogers, Steven
Walters, Jennifer
Charles, Luke
Banner, Robert Bruce
Maximoff, Pietro
Shade, Victor
Danvers, Carol

GURVITZ & MARLOWE LLP

GURVITZ & MARLOWE LLP
Maximoff, Pietro
Parker, Peter
Danvers, Carol
Stark, Anthony
Odinson, Thor
Maximoff, Pietro
Maximoff, Wanda
Odinson, Thor
Parker, Peter
Maximoff, Wanda
Odinson, Thor
Parker, Peter
Rogers, Steven Rogers, Steven
Shade, VictorShade, Victor

ST MARYS US HEALTHWORKS
Stark, Anthony
Walters, Jennifer
Stark, Anthony
Odinson, Thor
Maximoff, Pietro
Parker, Peter

THE PERM MED FRP INC STR

US HEALTH & ORTHOPEDIC

US HEALTH & ORTHOPEDIC
US Health and Orthopedic Medic
US Health and Orthopedic Medic
US Health and Orthopedic Medic

US HEALTHWORKS
Danvers, Carol
Stark, Anthony
Rogers, Steven
Charles, Luke
Shade, Victor
Banner, Robert Bruce
Maximoff, WandaUS HEALTHWORKS MED GRP
6/5/2018 2:03:22 PM Page 1 of 3

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LWP Claims Solutions
Reconciliation Report
Sample Reconciliation
Bank 123
December-22
Prepared by:

Date Competed:

Stephanie Kinyon
1/10/2023
Reviewed by:

Date Reviewed:

Helen Costa
1/18/2023
Bank Balance Register Balance
Previous Balance (Per Statement) 4,792.24 Bank Balance 31,245.00 Checks and Payments - Cleared
Deposits and Credits - Cleared
Reconciled Items/Data Corrections, Sto
(249.23)
26,701.99
-
Checks and Payments (Outstanding)
Other Outstanding Items
(567.46)
-
Service Charge
Interest Earned
-
- Register Balance (Calculated) 30,677.54
Ending Balance (Calculated)
Ending Balance (Per Statement)
31,245.00 Register Balance (Per Origami Register)
31,245.00 Variance
30,677.54
-
Outstanding Items
Date Transaction ID Amount
Amount
Description
Total Outstanding Items -
Outstanding Checks
Date Check Number Payee Type
Issued
Issued
Claim
2212300096
2212300096
Claimant Name
Injured, Worker
Injured, Worker
12/21/2022
12/27/2022
6631
6632
498.46 Hand Therapy Doctors

69.00 Pharmacy
Total Outstanding Checks 567.46

Page 1 of 1 ends

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

225

Sample Municipality - Schools
Stewardship Report
As of
September 30, 2022
As of September, 2022 Page | 1

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226

Sample - Schools Claim Summary
Policy Year Closed Open Re-Open Grand Total # of Claims > Paid over $125k
Incurred
(Exc. Excess)Total Incurred $125k Incurred
07/01/2007-06/30/2008
07/01/2008-06/30/2009
07/01/2009-06/30/2010
07/01/2010-06/30/2011
07/01/2011-06/30/2012
07/01/2012-06/30/2013
07/01/2013-06/30/2014
07/01/2014-06/30/2015
07/01/2015-06/30/2016
07/01/2016-06/30/2017
07/01/2017-06/30/2018
07/01/2018-06/30/2019
07/01/2019-06/30/2020
07/01/2020-06/30/2021
07/01/2021-06/30/2022
07/01/2022-06/30/2023
Grand Total
285
266
253
230
225
211
215
222
225
217
211
235
150
65 3 1
2 1
1 1
289 $5,075,791
268 $3,214,056
255 $1,977,183
236 $4,200,118
226 $2,602,942
217 $2,575,033
221 $2,117,165
4 7
0 7
5 3
4 7
5 3
5 7
3 6
2 0
68 $2,428,865 $1,378,500
$1,287,362 $1,926,693
$0 $1,977,1831
5 $1,713,512 $2,069,951
$1,401,112 $1,201,831
$478,061 $1,849,508
$377,041 $1,448,655
$812,125 $1,576,057
$907,023 $1,923,183
$591,682 $1,664,098
$1,014,001 $1,727,275
$587,654 $1,592,276
$483,623 $1,729,377
6 5
4 6
5 1
2 2
` $2,774,687
233 $3,145,634
222 $2,672,291
223 $3,022,536
250 $3,001,637
171 $2,794,777
9 3
2 1
13 20
15 43
22 80
185 $1,651,031
24 $148,011
3100 $42,641,695
$1,668,804 $193,051
$0 $1,366,282
$0 $148,011
$12,275,111 $24,183,387
$604,507
142
2 3154 157 17
Valued as of 9/30/22
Claim Status as of 9/30/2022
350
300
250
200
150
100
50 0 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2015- 2016- 2017- 2018- 2019- 2020- 2021- 2022- 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Open 4 2 2 6 1 6 6 6 8 5 12 15 21 15 43 22
2Closed 285 266 253 230 225 211 215 222 225 217 211 235 150 65 142 Closed Open
As of September, 2022 Page | 2

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Summary of Claim Status as of
Total Open as of
First Aid
6/30/13
4 6/30/15 6/30/17
1 6/30/19
1 6/30/20
-
6/30/21 6/30/22 9/30/22
-
Indemnity 208
123
85 44
256
208
159
49 35
243
186
119
67 21
208
199
140
59 32
232
169
105
64 13
182
138
79 59
6 157
92 65
23 180
155
91 64
19 174
Indemnity
Future Medical
Medical Only
Grand Total 144
Total Outstanding as of
First Aid
6/30/13
$2,883
6/30/15 6/30/17
$1,690
6/30/19
$230
6/30/20 6/30/21 6/30/22 9/30/22
$0 $0 $0 $0 $0
Indemnity $10,019,312 $8,877,385 $6,810,457 $7,408,742 $7,899,344 $6,781,321 $7,086,953 $7,039,195 $3,660,941 $5,483,740 $3,160,378 $3,552,145 $3,779,900 $3,361,412 $3,348,313 $3,450,220 $6,358,370 $3,393,645 $3,650,078 $3,856,597 $4,119,443 $3,419,909 $3,738,640 $3,588,975 Indemnity
Future Medical
Medical Only
Grand Total
$26,986 $81,952 $54,406 $59,104 $36,784 $17,624 $110,542 $93,312 $10,049,181 $8,959,337 $6,866,553 $7,468,076 $7,936,128 $6,798,945 $7,197,495 $7,132,507 Total Incurred as of
First Aid
6/30/13
$3,162
6/30/15
$6,057
6/30/17
$17,171
6/30/19
$17,429
6/30/20
$17,701
6/30/21
$17,701
6/30/22
$18,672
9/30/22
$19,425
Indemnity $19,467,231 $23,754,090 $27,428,053 $33,275,919 $36,538,471 $37,886,846 $40,895,561 $41,344,001 $7,729,125 $13,204,855 $14,059,231 $18,231,993 $19,327,520 $19,797,760 $21,279,344 $21,794,425 $11,738,106 $10,549,235 $13,368,822 $15,043,925 $17,210,951 $18,089,086 $19,616,217 $19,549,576 Indemnity
Future Medical
Medical Only
Grand Total
$388,281 $611,749 $760,394 $964,300 $1,065,562 $1,093,038 $1,271,839 $1,278,269 $19,858,674 $24,371,896 $28,205,618 $34,257,647 $37,621,734 $38,997,585 $42,186,072 $42,641,695 Claims Open as of
300
256 243 232250
200
150
100
50 208
182 180 174
144
0 June 2013 June 2015 June 2017 June 2019 June 2020 June 2021 June 2022 Sep-22 As of September, 2022 Page | 3

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Paid by Category
Paid in Period 7/1/2018 - 7/1/2019 - 7/1/2020 - 7/1/2021 - 7/1/2022 - 6/30/2019 6/30/2020 6/30/2021 6/30/2022 6/30/2023
Payment Category
Exp
Med
$406,151 $383,002 $202,965 $239,241
$1,507,704 $1,279,544 $1,134,343 $1,366,340 $265,923
$4,420 $9,142 $12,898 $2,600
$73,015
Rehab
Ind $927,661 $1,151,697 $1,308,917 $1,184,309 $182,426
Salary Continuation
Temporary Disability
Permanent Disability
Settlement
Grand Total
$632,788 $586,753 $567,159 $936,462 $127,609
$171,326 $415,822 $431,306 $239,736
$123,547 $149,121 $310,453 $8,110
$54,818
$0
$2,841,516 $2,818,663 $2,655,368 $2,802,787 $523,965
Claims by Union
Date of loss 7/1/2018 - 9/30/2022
Union Total Claims Total
Incurred
Closed
Claims
Closed Total
Incurred
Open
Claims excl FM
FM
Open Open Total
Incurred

TEAMSTERS--M& O
MDEA
CSEA
TEAMSTERS--Transp
CST
DMA
218
171
167
35 28
23 7
28 10
8 $4,314,699
$1,768,712
$1,613,217
$729,420
$259,345
$227,075
$100,616
$117,772
$65,316
182
139
141
28 24
21 6
24 8
7 $1,150,401
$279,728
$463,874
$110,126
$61,484
$90,640
$13,383
$31,417
$6,764
25 29
23 7
3 2
0 4
2 1
11 3
3 0
1 0
1 0
0 0
0 0
0 $3,164,297
$1,488,984
$1,149,343
$619,294
$197,861
$136,435
$87,234
$86,355
$58,552
$18,970
$13,357
$0
MDSPA

SUBSTITUTE

CLASSIFIED UNREPRESENTED

TEAMSTERS --TIS
TEAMSTERS--FS (food services)

SUPERVISORY

VOLUNTEER
$29,042
$27,301
$2,403
$9,343
$10,072
$13,944
$2,403
10 4
1 9
4 1
1 0
0$9,343 $0
Grand Total 710 $9,264,259 594 $2,243,578 97 19 $7,020,681 As of September, 2022 Page | 4

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Occupations by Incurred - Up to 90% of Incurred
Dates of loss 7/1/18 to 9/30/2022
Occupation Total Incurred # of Claims Total Outstanding % of Incurred SEA II
Mech Service Te ch
Teacher
Bus Driver
Teacher SDC
Custodian PM
Custodian
SEA
Groundskeeper Gardener
Medium Equip Operator
Mech Serv Te ch Leadworker
Resource Specialist
Maintenance
$950,949
$805,018
$790,683
$699,487
$698,592
$634,864
$476,768
$422,140
$300,338
$291,544
$279,934
$251,586
$196,276
$180,547
$161,415
$153,206
$140,142
$128,910
$127,628
$110,190
$109,890
$108,626
$89,183
102
8 $389,487
$310,512
$355,319
$319,436
$225,210
$241,244
$132,039
$155,009
$102,484
$89,225
$74,268
$133,098
$43,871
$76,848
$77,776
$30,200
$26,762
$77,799
$0
10%
9%
9%
8%
8%
7%
5%
5%
3%
3%
3%
3%
2%
2%
2%
2%
2%
1%
1%
1%
1%
1%
1%
1%
1%
1%
100%
120
45 30
31 44
13 9
10 1
9 15
4 4
2 11
4 1
7 6
1 4
4 9
13 710
Plumber
Electrician
Gen Maint Worker
Groundskeeper
Administrator
Sr Bldg Trades Leadworker
Secretary
Custodian Sub
Area Facilities Manager
Behav Health Specialist II
Equip Mechanic Tech
SEA IV
$21,162
$37,036
$24,324
$41,926
$0$86,607
$75,482
$68,005
$0
SEA I
Total
$26,976
$3,190,863$9,264,259
As of September, 2022 Page | 5

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Occupation Custodian (Including Related Occupations)
Dates of loss 7/1/18 to 9/30/2022
Cause of Injury Total Average
Incurred
$178,586
$12,670
$12,849
$9,116
% of Total
Incurred
27%
21%
16%
8%
5%
5%
4%
3%
3%
2%
6%
100%
Total # of # of all Open
Incurred
$357,171
$278,733
$218,429
$109,391
$68,575
$60,777
$57,255
$36,124
$35,764
$31,334
$82,663
$1,336,217
Claims
2 22
17 12
5 Claims
Other-Miscellaneous, NOC
Lifting
Fall, Slip, Trip, NOC
Strain or Injury By, NOC
Striking Against or Stepping On, NOC
Collision or Sideswipe with Another Vehicle
Slipped, Did Not Fall
Struck or Injured, NOC (Includes Kicked, Stabbed, Bi
Twisting
1 3
3 1
1$13,715
$60,777
$57,255
$2,779
$11,921
$7,834
1 1
13 3
2 1
Cumulative, NOC
All Other
Grand Total
4 $5,166
$13,919
16 96
3 15
Nature of Injury Total Average
Incurred
$13,947
$59,609
$6,420
$15,470
$27,500
$9,020
$3,110
$5,696
$1,077
$1,203
$754
% of Total
Incurred
55%
27%
12%
2%
Total # of # of all Open
Incurred
$739,167
$357,654
$154,078
$30,941
$27,500
$9,020
Claims Claims
Strain 53
6 12
1All Other Specific Injuries, NOC
Contusion
Hernia
Mental Stress
Death - Specific
Sprain
Crushing
Laceration
No Physical Injury
All Other
24 2
1 2%
1%
0%
0%
0%
0%
0%
1 1
1 2
1 3
$6,219
$5,696
$3,232
$1,203 1
$1,507 2 0
Grand Total $1,336,217 $13,919 100% 96 15
Body Part Injured Total Average
Incurred
$61,567
$11,128
$19,929
$11,251
$17,975
$12,607
$7,864
% of Total
Incurred
41%
17%
12%
10%
4%
4%
4%
1%
1%
1%
4%
100%
Total # of # of all Open
Incurred
$554,107
$233,697
$159,430
$135,009
$53,924
$50,428
$47,185
$17,507
$15,221
$10,925
$58,784
$1,336,217
Claims Claims
Knee
Multiple Body Parts
Shoulder(s)
Lower Back Area (Lumbar and Lumbo-Sacral)
Abdomen Including Groin
Finger(s)
Ankle
Wrist
Hand
9 21
8 12
3 4
4 2
1 4
6 1
1 $8,754
$3,805
$10,925
$2,261
$13,919
2 4
1Lower Leg
All Other
Grand Total
26 96
2 15
Included Occupations; Cust Leadworker I, Cust Leadworker II, Custodian, Custodian PM Roving, Custodian PM, Custodian Sub, Custodian Traveling, Elem Custodian Head, Elem Head Cust Followed by Other Specified Occupational Groups based on Client Preference As of September, 2022 Page | 6

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Claims by Department
Dates of loss 7/1/18 to 9/30/2022
Department Closed Claims Closed Total Open Claims Open Total Total Claims Total Incurred Incurred
$599,189
Incurred
$2,860,518
$1,087,415
$1,138,579
$1,046,859
$486,049
$167,104
$87,234
Elementary Schools
Maintenance
Transportation
High Schools
Middle Schools
Alternative Education
Administration
Food Service
209
79 47
101
76 38
12 8
35 15
10 23
17 8
244
94 57
124
93 46
$3,459,707
$1,776,583
$1,343,277
$1,266,709
$735,339
$336,133
$134,133
$88,015
$689,168
$204,698
$219,850
$249,290
$169,029
$46,900 1
2 13
10$16,450 $71,564
Other
Preschool Programs
Grand Total
17 7
594
$38,997
$10,008
$2,243,578
2 3
116
$48,149
$27,210
$7,020,681
19 10
710
$87,146
$37,217
$9,264,259
As of September, 2022 Page | 7

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Administration
Locations Within Department
7/1/18 - 9/30/22
# of Closed Total Incurred # of Open Total Incurred Total # of Total Incurred Claims Closed Claims Claims Open Claims Claims
Central Kitchen
Dent Center
1 2
1 2
1 298.87
5,771.40
259.49
490.81
6,976.74

0.00 0.00

0.00 1
2 1
2 1
1 1
1 298.87
5,771.40
259.49Director of Personnel
Director Student Services
Director Tech & Info Services
District-Wide
Exec Dir Instruct Support
Fiscal Services
490.81
6,976.74
87,233.52
1,291.39
985.97
87,233.52

0.001
1 1,291.39
985.97 0.00
Purchasing Department
Special Education Director
Substitute Service
1 1
1 12
29,958.90
760.20
105.95
46,899.72

0.00 0.00

0.00 1
1 1
13 29,958.90
760.20
105.95
134,133.24
1 1Administration 87,233.52
Alternative Education
Locations Within Department
7/1/18 - 9/30/22
Facility 1
Facility 2
Facility 3
Facility 4
Facility 5
Facility 6
Facility 7
Facility 8
Facility 9
Facility 10
Facility 11
Facility 12
Facility 13
Facility 14
Alternative Education
# of Closed Total Incurred # of Open Total Incurred Total # of Total Incurred Claims Closed Claims Claims Open Claims Claims
2 1,089.18 0
1 0
3 0
1 0
0 1
0 0
1 1
0 8

0.00 1,980.00

0.00 2
1 1,089.18
1,980.00
6,694.10
143,693.08
6,216.69
22,040.14
64,243.09
603.50
1 12
3 7
5 6,694.10
61,130.68
6,216.69
18,928.14
64,243.09
603.50
1 15
3 8
5 82,562.40

0.00 3,112.00

0.00 1 0.00 1
2 2
2 3,220.93
1,079.03
733.92
56,921.75

0.00 3
2 2
60,142.68
1,079.03
733.920.00
7,489.82
15,038.33

0.00 1
1 1
46 7,489.82
15,038.33
5,089.32
336,132.88
1 38
5,089.32
169,028.58 167,104.30
Followed by other grouping by levels specified by Client As of September, 2022 Page | 8

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ꢀ
SampleꢀQuarterlyꢀStewardshipꢀ
Poolꢀ
Asꢀofꢀꢀ
Juneꢀ30,ꢀ2022ꢀ
ꢀ
ꢀ
ꢀ
As of June 30, 2022 Page | 1

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Julyꢀ1,ꢀ2013ꢀ‐ꢀPresentꢀ
Total Outstanding - All Claims Total Count of Open Claims 12,500,000
10,000,000
7,500,000
5,000,000
2,500,000
0 500
400
300
200
100
0 10,305,286 400
3057,378,790
July 2013 Jun-22 July 2013 Jun-22
As of June 30, 2022 Page | 2

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Sample Pool - 10 Year Claim Summary
Policy Year Grand Total Open by Claim Type
Total Incurred Indemnity MO First AidClosed Open Re-Open 07/01/2012-06/30/2013 372
07/01/2013-06/30/2014 369
07/01/2014-06/30/2015 363
07/01/2015-06/30/2016 403
07/01/2016-06/30/2017 393
07/01/2017-06/30/2018 367
07/01/2018-06/30/2019 375
07/01/2019-06/30/2020 330
07/01/2020-06/30/2021 299
07/01/2021-06/30/2022 185
2 4
3 6
9 3
1 2
377 $2,368,893
374 $2,670,571
368 $1,947,103
409 $4,354,870
404 $2,986,332
378 $1,459,670
399 $4,544,427
364 $4,055,672
350 $4,723,672
269 $2,187,884
3692 $31,299,094
4 5
5 6
10 9
21 29
38 24
151
1 2
6 4
5 7
1 2
3 5
20 29
44 82
5 13
60 85
2 32Grand Total 3456 204 0
Valued as of 6/30/22
As of June 30, 2022 Page | 3

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Summyar of Claim Status as of
Total Opena s of
AitFisdr
//13063 /4/6013 //05631 //01663 /76/301
1 /0/1863 /96/301 /0/2063 /16/023 /23/312
3 1 1 2 3 1
eiIndnymt 406
163
243
-
682
042
962
832
762 072 842 032 212
251
652
701
941
932
141
Indenimyt 64 13
46 33 43 29
14 15 06
57 89
elediauFurt Mc
lynl OaicdeM
ato TdnaGr
432 632 651 971
95 54 16 35 06 38
604 843 433 313 233 982 582 092 713 223
Total Outstanding as of
AitFisdr
//13063 /4/6013 //05631 //01663 /76/301 /0/1863 /96/301 $1,315
/0/2063
$3,579
/16/023 /23/312
$250 $215 $120 $200 $0
eiIndnymt $11,080,953 $8,429,638 $6,736,596 $5,953,507 $5,901,862 $5,584,310 $6,500,820 $5,976,441 $1,857,474 $878,656 $665,027 $550,706 $653,619 $913,022 $2,283,857 $2,324,576 $9,223,479 $7,550,982 $6,071,569 $5,402,800 $5,248,242 $4,671,289 $4,216,963 $3,651,865 $83,917 $237,942 $107,226 $149,888 $148,480 $317,041 $440,860 $9,271,073
$5,586,159
$3,684,914
$378,318
$7,846,665
$4,499,517
$3,347,147
$559,098
Indenimyt
elediauFurt Mc
lynl OaicdeM
Grand Total $11,080,953 $8,513,805 $6,974,753 $6,060,733 $6,051,869 $5,732,790 $6,819,175 $6,420,880 $9,649,591 $8,405,762 Total Incurreda s of
AitFisdr
//13063 /4/6013
$10,066
//05631
$12,696
//01663
$13,507
/76/301
$13,627
/0/1863
$13,809
/96/301
$15,124
/0/2063
$17,659
/16/023
$15,094
/23/312
$15,427
eiIndnymt $79,727,738 $76,629,536 $77,634,121 $79,408,141 $82,118,974 $84,849,607 $89,044,047 $91,684,712 $100,094,770 $103,231,077 $54,103,310 $50,989,909 $51,470,959 $52,088,995 $52,932,332 $54,305,221 $57,158,704 $58,875,752 $65,488,612 $67,843,118 $25,624,428 $25,639,627 $26,163,162 $27,319,146 $29,186,641 $30,544,386 $31,885,343 $32,808,960 $34,606,158 $35,387,959 Indenimyt
elediauFurt Mc
lynl OaicdeM
Grand Total
$3,000,978 $3,323,434 $3,345,581 $3,604,729 $3,865,149 $4,244,197 $4,686,574 $4,705,270 $5,047,843 $79,727,738 $79,640,580 $80,970,251 $82,767,229 $85,737,329 $88,728,565 $93,303,368 $96,388,945 $104,815,134 $108,294,347 22 As of June 30, 20 Page | 4

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MemberꢀClaimꢀSummaryꢀwithꢀallꢀMembersꢀwithꢀClaimsꢀAfterꢀ7/1/2016 2016-2017 2017-2018 2018-2019 2019-2020 2020-2021 2021-2022 Total # of Claims Total Incurred# of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred Member 1
Member 2
Member 3
Member 4
Member 5
Member 6
Member 7
Member 8
Member 9
Member 10
Member 11
Member 12
Member 13
Member 14
Member 15
Member 16
GrandꢀTotal
1 $1,311
$428,717
$627,341
$240,937
$237,125
1 $4
$426,775
$720,494
$4,754
2 440
384
54 386
1 832
1 1
3 28
2 7
1 $1,315
$5,992,751
$3,533,364
$434,514
$2,734,013
$4,917
73 78
8 74
55 6
$317,037
$259,146
$2,752
93 65
12 68
$1,156,491
$725,081
$56,600
65 54
7 88
1 $1,546,622
$548,110
$32,654
$507,659
$4,917
75 66
10 78
$2,117,109
$653,192
$96,818
60 66
11 4352 57 $375,505 $506,009 $970,621 $137,093
175 $1,237,559 171 $393,116 148 $1,922,618 143
1 $1,414,982
$112
113 $714,852
$169,221
82 $362,438
$7,484
$6,045,565
$112
1 1
4 $177
$102
$26,591
$177
$305
$272,817
$4,367
$387,067
$151
2 7
$204
$1,8799
2 2
$67,166
$4,367
$127,048
1 $476 5 2
1 1
4 $109,779
$151
4 $150,240
3 1
404
$14,748
$13
$2,986,332
$100 2
1 399
$326
$193
$4,544,427
4 $140 2
1 350
$1,550
$309
$4,723,672
4 $23,946 19
3 2164
$40,811
$514
$19,452,761378 $1,459,670 364 $4,055,672 269 $1,682,988 PaidꢀinꢀYearꢀbyꢀPaymentꢀCategory
PaidꢀinꢀPeriod
Indemnity
2016‐17 2017‐18 2018‐19 2019‐20 2020‐21 2021‐22 GrandꢀTotal $905,381 $1,299,215 $1,706,916 $1,285,587 $1,165,132 $2,086,210 $207,144 $233,827 $193,912 $164,953 $430,429 $409,313
$471,483 $738,860 $747,774 $649,260 $523,801 $655,157
$219,701 $311,223 $751,883 $450,337 $190,256 $1,005,845 $8,448,441
$1,639,577
$3,786,336
$2,929,246
$93,282
Temporary Disability
Permanent Disability
Settlement
Other Indemnity
4850
Medical
$7,053 $15,305 $13,347 $21,036 $20,645 $15,896
$704,403 $542,567 $555,006 $911,689 $1,673,943 $1,288,144 $1,115,778 $1,261,354 $987,469 $1,090,424 $2,134,800 $1,120,657 $812,544 $849,925 $822,099 $875,097 $1,571,527 $945,967 $5,675,751
$7,710,483
$5,877,159
$80,150
Medical
Nurse Case Management
Hospital & Surgery
Expense
$507 $0 $0 $1,857 $49,456 $28,331
$302,728 $411,428 $165,371 $213,471 $513,818 $146,359
$261,727 $241,282 $267,130 $268,352 $230,650 $241,416
$211,681 $194,847 $213,485 $218,249 $164,626 $204,632
$1,753,174
$1,510,559
$1,207,520
$52,577
Other Expense
Utilization Review
Bill Review
$11,158
$38,888
$8,496
$37,939
$13,530
$40,116
$6,816
$43,288
$8,536
$57,489
$4,042
$32,742 $250,462
GrandꢀTotal $2,987,290 $3,344,419 $3,516,521 $3,556,052 $5,204,526 $4,736,427 $23,345,235 As of June 30, 2022 Page | 5

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CovidꢀSummary
ClaimꢀTypeꢀ
Indemnity Medicalꢀ FirstꢀAid
Openꢀasꢀofꢀ3/31/2022
Indemnity Medicalꢀ FirstꢀAidReported TotalꢀClaims TotalꢀIncurred 2020
Qtr1
Qtr2
Qtr3
Qtr4
2021
Qtr1
Qtr2
Qtr3
Qtr4
2022
Qtr1
Total
2 2
1 2
4 4
29 23
6 6
30 31
$5,187.98
$62,819.01
$8,870.32
$32,235.97
1 6
2 1
1 5
3 7
4 8
3 8
$1,626.21
$4.00
$13,296.55
$2,817.31
1 1 5 10
2 81
39 52
41 143
$294.00
$127,151.35
2 310 1 0
As of June 30, 2022 Page | 6

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Member C - Recent Claim Summary
Contract Year Grand Total Open by Claim Type TotalClosed Open Re-Open Total Incurred Indemnity MO First Aid Open 07/01/2016-06/30/2017
07/01/2017-06/30/2018
07/01/2018-06/30/2019
07/01/2019-06/30/2020
07/01/2020-06/30/2021
07/01/2021-06/30/2022
Grand Total
52 53
64 78
69 52
57 68
88 78
$237,125
$375,505
$506,009
$507,659
$970,621
$137,093
$2,734,013
0 4
4 10
9 10
37 2
3 7
8 10
30 2
1 3
1 3
3 7
9 4
1 1
3 33
349
43 386
6 117 26 0
Valued as of 6/30/2022
PaidꢀinꢀYearꢀbyꢀPaymentꢀCategory
PaidꢀinꢀPeriod
Indemnity
2016‐17 2017‐18 2018‐19 2019‐20 2020‐21 2021‐22 GrandꢀTotal $93,883
$12,687
$44,097
$31,099
$6,000
$69,449 $144,471 $133,261 $146,276 $150,336 $737,676
$168,478
$386,808
$148,859
$33,532
Temporary Disability
Permanent Disability
Settlement
$6,825
$40,244
$16,380
$6,000
$2,194
$94,253
$40,822
$7,202
$34,050
$54,867
$32,255
$12,090
$28,488
$98,088
$17,555
$2,145
$84,233
$55,260
$10,748
$95Other Indemnity
4850
Medical
$28,813 $41,701 $191,102 $241,336 $176,276 $256,481 $935,708 $788,639
$640,473
$1,714
$146,453
$132,491
$97,060
$109,696 $122,847 $125,742 $153,142 $125,001 $152,211
$96,289 $104,574 $93,987 $108,399 $96,546 $140,679Medical Nurse Case Management
Hospital & Surgery
Expense
$0
$13,407
$28,496
$23,255
$280
$0
$18,273
$18,373
$13,133
$670
$0
$31,755
$25,254
$18,946
$1,693
$633
$44,111
$16,894
$9,464
$280
$0
$28,455
$20,708
$13,506
$0
$1,081
$10,451
$22,767
$18,757
$0
Other Expense
Utilization Review
Bill Review
$2,923
$4,961 $4,570 $4,615 $7,150 $7,202 $4,010 $32,508
GrandꢀTotal $260,887 $252,370 $486,568 $544,633 $468,260 $581,795 $2,594,514 As of June 30, 2022 Page | 7

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MemberꢀCꢀClaimꢀSummaryꢀ‐ꢀContinuedꢀ
CovidꢀSummary
ClaimꢀTypeꢀ
Indemnity Medicalꢀ FirstꢀAidReported TotalꢀClaims TotalꢀIncurred 2020
Qtr1
Qtr2
Qtr3
Qtr4
2021
Qtr1
Qtr2
Qtr3
Qtr4
2022
Qtr1
Total
2 1
17 9
2 1
18 14
$0.00
$396.99
$7,503.43
$2,889.18
1 5
1 1
1 0
3 0
$1,313.77
$0.00
$13,284.55
$0.00
2 3
8 3
42 $0.00
$25,387.923 31
Topꢀ5ꢀDepartmentsꢀforꢀPYꢀ2019/20ꢀ‐ꢀ2021/22
# of Claims Total Outstanding Total Incurred
$393,724.51 $1,049,086.35
$152,758.28 $436,785.76
Police
Fire
103
61 20
3 14
201
Recreation
Community Development
Public Works
$7,966.07
$15,704.74
$1,050.00
$62,044.75
$56,863.84
$5,386.40
Largest Departments by Total Incurred $571,203.60 $1,610,167.10 Followed by Summary for each Pool Member
As of June 30, 2022 Page | 8

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Open Claims by Member
Indemnity MO Future Medical Total # Total Outstanding Total Incurred Member 1
Member 2
Member 3
Member 4
Member 5
Member 6
Member 7
Member 8
Member 9
Grand Total
26 28
1 14
24 23
23 2
10 23
37 27
3 29
41 1
2 1
9 86
78 6
53 88
1 5
3 11
331
$2,299,690.93 $8,405,045.00
$1,635,378.24 $4,112,615.00
$103,848.19 $505,580.00
$995,398.09 $3,260,189.00
$2,919,255.79 $11,689,259.00
$36,298.65
$307,184.46
$97,833.24
$10,874.83
$90,579.00
$835,949.00
$201,062.00
$23,792.00
3 1
1 1
1 8398 150 $8,405,762.42 $29,124,070.00
10ꢀLargestꢀOpenꢀClaimsꢀbyꢀOutstanding
PolicyꢀPeriod EmployerꢀName Levelꢀ1 ClaimꢀNumber FutureꢀMedical TotalꢀPaidꢀNet TotalꢀOutstanding TotalꢀIncurredꢀNet 07/01/2020 - 06/30/2021 Member A
07/01/2021 - 06/30/2022 Member B
07/01/2019 - 06/30/2020 Member C
07/01/2009 - 06/30/2010 Member D
07/01/2015 - 06/30/2016 Member E
07/01/2008 - 06/30/2009 Member F
07/01/2006 - 06/30/2007 Member G
07/01/2019 - 06/30/2020 Member H
07/01/2018 - 06/30/2019 Member I
07/01/2019 - 06/30/2020 Member j
Public Works
Fire
Sheriff-Civil
Sheriff-Patrol
Sheriff-Patrol
Police
Elementary School
General Services Departm
District Attorney
Police
1 False
2 False
3 False
4 True
5 True
6 True
7 True
8 False
9 False
10 False
$101,281
$4,436
$342,812
$287,151
$222,813
$203,761
$200,644
$175,540
$167,875
$157,434
$143,913
$138,383
$2,040,326
$444,093
$291,586
$443,238
$562,867
$411,789
$460,002
$451,785
$383,371
$211,281
$303,416
$3,963,429
$220,425
$359,106
$211,145
$284,462
$283,910
$225,937
$67,368
$165,033
$1,923,102
As of June 30, 2022 Page | 9

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Monthly Summary November 2022:

During November, we saw the overall claim inventory decrease to 132 open claims. Total new claims added for the month of November was eight. There was one Indemnity, six Medical Only and one FA claims. Five were Classified employees and three were Certificated. There were no Awards or requested settlements during the month. Total average reserve change during November was the 2nd highest within the past 12 months. Finally, eight employees received TTD benefit payments at the end of November.

The Team continues to push for resolution of the Claimant A and Claimant B claims. On the B claim, the MSA was approved, settlement documents sent, and AA wishes to move forward with the structured settlement; however, Excess carrier preference is a lump sum, so discussions continue on method of settlement. On the Johnson file, the MSA has been approved, settlements documents sent, and AA and DA have finally agreed on the language on the C&R. DA is waiting for signatures, so he can walk through the settlement. The Team also continues to push older unresolved claims, while pushing the newer claims to close/resolve sooner to reduce the outstanding exposure and liabilities of the district. Of the claims from FY’s 2017, 2018 and 2019, forty (40) remain open with only eighteen (18) IND claims left to resolve. The number of open, unresolved claims for FY’s 2017-19 remained the same from the prior month.

MONTHLY CLAIM CHANGES NOVEMBER 2022
Open Inventory Re-
Open
Conversions Total Open InventoryOpen-New Closed10/31/22 11/30/22 Indemnity
Future Medical
Medical
First Aid
Grand Total
68 42
29 0
1 0
6 1
8 0
0 0
0 0
0 0
0 0
0 5
0 9
1 15
64 42
26 0
132139

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New Claims November 22:

Claim
Number Claimant
Total Employee
Incurred Class
Type Of
ClaimLoss Date Occupation
11/18/2022 Teacher
11/17/2022 TK Para Educator
11/17/2022 Teacher
11/15/2022 Teacher
11/14/2022 Special Ed Teacher
10/31/2022 Custodian
2293800121
2293800120
2293800119
2293800118
2293800117
2293800116
2293800115
2293800114
Claimant A
Claimant B
C
D
E
F
G
H
$1,500.00 Certificated
$4,200.00 Classified
$1,600.00 Certificated
$18,459.44 Certificated
$0.00 Classified
$1,600.00 Classified
$16,000.00 Classified
$1,100.00 Classified
Medical
Medical
Medical
Indemnity
First Aid
Medical
Medical
Medical
11/20/2020 Care Asst Teacher
10/27/2022 Paraprofessional 3
Closed Claims November 22:

Claim
Number Claimant
Employee
Class
Total Type Of
Loss Date Occupation
11/14/2022 Special Ed Teacher
10/27/2022 Custodian
09/29/2022 Site Computer Tech
09/28/2022 Academic Specialist
09/21/2022 Special Ed. Teacher
09/16/2022 Para Professional 1
Incurred Close Date Claim
$0.00 11/15/2022 First Aid
$157.50 11/23/2022 Medical
$738.06 11/14/2022 Indemnity
$440.70 11/21/2022 Indemnity
$166.04 11/21/2022 Medical
$593.87 11/29/2022 Medical
$221.52 11/14/2022 Medical
$221.52 11/03/2022 Medical
$11.55 11/29/2022 Medical
$178.87 11/07/2022 Medical
$647.17 11/10/2022 Indemnity
$772.96 11/28/2022 Medical
$2,486.73 11/14/2022 Medical
2293800117
2293800112
2293800106
2293800103
2293800099
2293800095
2293800093
2293800092
2293800091
2293800085
2293800080
2293800076
2293800045
Claimant 1
Claimant 2
3 4
5 6
7 8
Classified
Classified
Classified
Classified
Classified
Classified
09/14/2022 Speech Language Pathologist Classified
09/12/2022 Teacher
09/13/2022 Kindergarten Teacher
09/02/2022 Custodian
08/31/2022 Paraprofessional 3
08/29/2022 Plant Supervisor
04/06/2022 Speech Therapist
Certificated
Certificated
Classified
Classified
Classified
Classified
9 10
11 12
13 6.10
Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

244

2193800037
1493800026
Claimant 1
Claimant 2
08/27/2021 Child Nutritionist Assistant 1
08/12/2014 custodian
Classified
Classified
$26,829.02 11/28/2022 Indemnity
$21,023.72 11/21/2022 Indemnity
Claim Settlements:

There were no settlements Awarded, nor requested during the month of November.

Monthly Outstanding Reserves, Total Incurred and Paid Comparison:

Total Outstand. Reserve 10/31/22
$6,569,119
Total Outstand. Reserve 11/30/22
$6,732,099
Net Monthly Change
$162,980
Total Incurred 10/31/22
$52,013,350
Total Incurred 11/30/22
$52,296,253 $282,903
$209,923
Total Paid 10/31/22
$45,354,231
Total Paid 11/30/22
$45,564,154

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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** The largest increase during the month of November was the claim of Claimant 1 ($177,137) based on future medical over ALE, PD pursuant to QME findings, cost containment and legal costs for resolution of New and Further disability.

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TTD/IDL PAYMENTS – END OF NOVEMBER 2022 Top 10 Open Claims by Total Outstanding Claim
Number
1993800056
1893800068
2293800118
Pay From
Date
11/8/2022
2/17/2022
Pay To
Date
11/21/2022 $2,430.54
2/17/2022 $130.78
11/27/2022 $3,101.29
Claim
Number Claimant
1993800034
Total Type Of
Incurred Claim
$447,676.14 $1,094,977.18 $1,542,653.32 Indemnity
Employee Name DOI Amount Total Paid Outstanding FM
No
Yes
No
No
No
No
Yes
No
Yes
No
9/3/2018
8/13/2018 0493800011
1093800002
0093800051
0193800053
1593800042
1493800024
0893800052
0293800028
1793800013
$564,158.20
$354,089.73
$760,029.98
$750,792.29
$314,154.80
$318,835.68
$172,882.33
$189,016.97
$122,722.77
$648,293.27 $1,212,451.47 Indemnity
$433,539.55 $787,629.28 Indemnity
$376,033.45 $1,136,063.43 Indemnity
$293,351.36 $1,044,143.65 Indemnity
11/15/2022 11/15/2022
2293800031 3/24/2022 11/15/2022 11/28/2022 $618.80
$272,661.34
$176,689.33
$147,287.89
$112,688.29
$111,595.84
$586,816.14 Indemnity
$495,525.01 Indemnity
$320,170.22 Indemnity
$301,705.26 Indemnity
$234,318.61 Indemnity
2093800023
2293800065
2293800071
2293800088
5/8/2020
7/15/2022
8/16/2022
9/8/2022
11/10/2022
11/9/2022
11/9/2022
11/17/2022
11/23/2022 $1,727.16
11/22/2022 $1,298.60
11/22/2022 $1,388.44
11/30/2022 $825.92
* Denotes Voucher issued to the District

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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Overall Program: Open Claim Inventory:

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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Local Municipality As of 6-30-22
Claims Per Fiscal Year 7-1-13 to 6-30-22
LitgatedPolicy Year Claim Count Total Paid Total Outstanding Total Incurred Count in Last 5 Years % Average of Net Total Paid $26,848.07
$1,763.04
Average of Net Total Incurred
$33,573.667/1/2005
7/1/2006
7/1/2007
7/1/2008
7/1/2009
7/1/2010
7/1/2011
7/1/2012
7/1/2013
7/1/2014
7/1/2015
7/1/2016
7/1/2017
7/1/2018
7/1/2019
7/1/2020
7/1/2021
7/1/2022
10 $2,881.73 $0.00
$0.00
$0.00
$0.00
$0.00
$2,881.73
$193,929.00
$46,125.46
$73,522.07
$28,376.94
$1,395.79
$702,989.43
$57,210.87
$197,029.64
$3,307.00
$238,904.85
$70,572.94
$1,407.83
$1,506.78
$2,316.06
True
Non litigated
Total
3 37
40 7.50%
17 $193,929.00
13 9
5 6
8 4
4 8
7 9
4 2
9 13
9 7
$1,913.67
$46,125.46
$73,522.07
$28,376.94
$1,395.79
$447,808.37
$57,210.87
$197,029.64
$3,307.00
$238,904.85
$70,572.94
$1,407.83
$1,506.78
$2,316.06
$0.00
$255,181.06
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
7-1-13 to 6-30-22
Department Claim Count Total Paid
$3,079.23
Total Outstanding Total Incurred
8 3
3 13
8 1
$1,320.00
$0.00
$4,399.23
$1,367.05
$51,069.73
$51,568.48
$61,424.07
$95.48
Cafeteria $1,367.05
$51,069.73
$31,391.71
$57,170.82
$95.48
District Office
Elementary School
High School
Madison High School
Maintenance
$0.00
$20,176.77
$4,253.25
$0.00
$75,610.41
$65,014.02
$1,329.57
$24,430.02
$0.00
$1,320.00
$100,040.43
$65,014.02
$2,649.57
3 1
$1,380.00
$222.82
$0.00
$0.00
$1,380.00
$222.82Transportation
Grand Total 40 $145,776.84 $25,750.02 $171,526.86
Type of Claim
7/1/2018
Indemnity
7/1/2019
First Aid
Indemnity
Medical Only
7/1/2020
First Aid
Indemnity
Medical Only
7/1/2021
First Aid
Indemnity
Medical Only
7/1/2022
First Aid
Count Policy Year
7/1/2000
Claim Count Average Cost All Open
Policy Year
Future Medical
7/1/2008
7/1/2019
Indemnity
7/1/2019
2 2
9 3
1 5
13 1
4 8
9 2
2 5
7 1
6 10
17 13
9 5
6 $288.17
$11,407.59
$3,548.11
$8,169.12
$5,675.39
$232.63
Claim Count Total Paid
$342,128.27
$319,470.91
$22,657.36
$28,623.22
$28,623.22
$0.00
Total Outstanding Total Incurred
7/1/2001
7/1/2002
7/1/2003
7/1/2004
7/1/2005
7/1/2006
7/1/2007
7/1/2008
7/1/2009
7/1/2010
7/1/2011
7/1/2012
7/1/2013
7/1/2014
7/1/2015
7/1/2016
7/1/2017
Average
3 2
1 1
1 1
1 5
$259,434.31
$255,181.06
$4,253.25
$20,176.77
$20,176.77
$1,320.00
$601,562.58
$574,651.97
$26,910.61
$48,799.99
$48,799.99
$1,320.008
4 4
8 $55,976.05
$14,302.72
$49,257.41
$413.38
Medical Only
7/1/2022
Total
$0.00
$370,751.49
$1,320.00
$280,931.08
$1,320.00
$651,682.57
7 9
4 $34,129.26
$7,841.44
$351.96
2 $753.39
9 $257.34
13 9
7 $5,816.19
$7,223.78
$189.94
Medical Only
8 $11,435.21

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LWP Claims Solutions, Inc
Pool Client Sample Reserve Change Summary
04/2020 – 03/2021
Reserve Change by Period
2,000,000.00
1,500,000.00
1,000,000.00
500,000.00
-
Total Open Claims as of
330
320
310
300
290
280
270
260
250

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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LWP Claims Solutions, Inc
Claims Reported by Period by Type
50 45
40 35
30 25
20 15
10 5
0 Indemity Medical First Aid

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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LWP Claims Solutions, Inc
Claims with Reserve Change over $50k from 4/2020 – 3/2021 Employer
Name
Member 5
Claim Number Loss Date Status Reserve Change in Period
672,731.68100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
4/28/2016
1/21/2020
9/12/2020
11/21/2016
8/16/2015
2/12/2019
6/3/2020
6/14/2019
9/18/2020
4/7/2019
6/30/2017
9/18/2016
5/31/2020
6/17/2020
8/16/2018
8/16/2020
12/13/1994
8/20/2019
9/19/2020
4/3/2014
4/21/2020
2/12/2020
8/3/2016
1/9/2020
5/9/2019
8/23/2020
9/13/2020
6/5/2019
11/19/2003
11/8/2020
10/9/2014
8/1/2019
7/7/2020
5/8/2020
2/24/2020
5/23/2019
6/4/2020
8/5/2020
6/1/2006
5/6/2020
4/2/2020
3/3/2014
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
R
C
Member 5
Member 5
Member 3
Member 5
Member 5
Member 5
Member 2
Member 1
Member 5
Member 2
Member 5
Member 1
Member 1
Member 5
Member 1
Member 1
Member 1
Member 4
Member 5
Member 1
Member 5
Member 5
Member 5
Member 1
Member 2
Member 1
Member 5
Member 2
Member 2
Member 5
Member 2
Member 2
Member 2
Member 1
Member 1
Member 2
Member 4
Member 5
Member 4
Member 1
Member 5
418,237.78
254,169.39
252,133.51
239,906.20
226,036.25
218,167.95
200,934.20
177,601.51
172,213.28
166,595.06
165,863.16
163,060.84
151,876.21
146,840.64
136,547.89
132,000.73
129,734.48
125,855.09
113,411.24
98,752.69
98,741.89
96,704.77
87,382.50
86,496.84
82,960.43
75,466.08
73,832.40
73,005.78
71,755.45
71,244.99
66,534.57
65,159.75
63,248.13
59,941.39
58,264.38
57,164.11
55,923.24
54,852.53
53,875.96
53,590.70
-173,168.00

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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CA Municipality Open Claim Log
Valued as of 11/30/2022
Level 1 Level 2 Claim Number Claimant Loss Date Type Of Claim Accepted, Delayed or Denied Open, Closed, or Re-Opened Total Incurred Net Adjuster User Employer: CA Municipality
Type Of Claim: None
CA Municipality POLICE
CA Municipality Fire
CA Municipality Fire
CA Municipality ENVIRONMENTAL UTILITIES 1996100048
CA Municipality POLICE
CA Municipality POLICE
1296100075
1796100038
1796100039
Ellliott, Sam
Sunshine, Walker Both
Inn, Dropp
Nut, Dough
Bay, Green
6/5/2012 I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Reopened
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
198,382.53 Adjuster 1
8,290.40 Adjuster 1
7,281.41 Adjuster 1
98,350.86 Adjuster 1
143,042.64 Adjuster 1
35,445.00 Adjuster 1
74,129.02 Adjuster 1
98,500.79 Adjuster 1
261,386.11 Adjuster 1
9,300.00 Adjuster 1
40,257.07 Adjuster 1
191,718.88 Adjuster 1
323,903.93 Adjuster 1
55,098.65 Adjuster 1
45,645.00 Adjuster 1
99,554.00 Adjuster 1
41,666.97 Adjuster 1
135,457.22 Adjuster 1
9,484.74 Adjuster 1
52,849.79 Adjuster 1
215,083.09 Adjuster 1
66,756.55 Adjuster 1
12,850.38 Adjuster 1
389,523.99 Adjuster 1
279,265.79 Adjuster 2
455,804.97 Adjuster 2
1,000.00 Adjuster 2
105,311.35 Adjuster 2
2,525.00 Adjuster 2
1,925.00 Adjuster 2
3,735.00 Adjuster 2
101,956.71 Adjuster 2
145,342.64 Adjuster 2
62,633.00 Adjuster 2
64,326.07 Adjuster 2
48,810.40 Adjuster 2
1,221,807.41 Adjuster 2
1,130,402.72 Adjuster 2
87,958.00 Adjuster 2
247,417.50 Adjuster 2
18,222.77 Adjuster 2
248,699.11 Adjuster 2
600,551.43 Adjuster 2
1,475.00 Adjuster 2
133,617.78 Adjuster 2
210,697.13 Adjuster 2
72,590.38 Adjuster 2
1,325.00 Adjuster 2
2,500.00 Adjuster 2
2,425.00 Adjuster 2
2,175.00 Adjuster 2
800.00 Adjuster 2
5/27/2017
5/27/2017
6/6/2019
4/2/2017
8/7/2019
8/15/2019
12/30/1985
7/11/2011
2/9/2020
11/3/2015
1/27/2011
8/1/2000
3/18/2015
10/31/2018
12/1/2018
9/24/1997
7/1/2009
5/23/2014
10/13/2005
5/24/2015
1/26/2000
5/14/2019
2/17/1999
5/15/2018
11/9/1992
11/22/2022
6/23/2021
8/16/2022
9/27/2022
10/5/2022
5/26/2016
12/24/2020
9/6/2016
6/11/2020
11/20/2019
5/26/2011
9/3/2015
9/3/2015
5/3/2020
5/19/2019
6/14/1990
11/7/1994
9/6/2022
2/25/2015
4/15/2019
5/31/2010
10/27/2022
9/28/2022
10/10/2022
10/21/2022
8/9/2022
1796100018
1996100066 Richard, Luis
CA Municipality ENVIRONMENTAL UTILITIES 1996100071 Jose, SaraAnn Ashli, Jacinda
Anthony, Dinah
Jessica, Adela
Dolores, Richard
Jacinda, Hugo
Anita, Tate
Hugo, Cory
Mayra, Amanda
Adela, Juan
CA Municipality FINANCE
CA Municipality POLICE
CA Municipality POLICE
CA Municipality POLICE
CA Municipality POLICE
CA Municipality Human Resources
CA Municipality POLICE
CA Municipality Fire
8596100080
1196100087
2096100015
1596100110
1196100009
0096100076
1596100026
1896100112
1896100126
9796100099
0996100059
CA Municipality Fire
CA Municipality POLICE
CA Municipality POLICE
Paula, Jesse
Grace, Susan
Debra, Bertha
Angelique, Arlita
Veronica, Rebecca
Janet, Maria
CA Municipality ENVIRONMENTAL UTILITIES 1496100049
CA Municipality LIBRARY
CA Municipality POLICE
CA Municipality POLICE
CA Municipality POLICE
CA Municipality PUBLIC WORKS
CA Municipality POLICE
CA Municipality POLICE
0596100104
1596100042
0096100006
1996100040
9996100014
1896100051
9296100125
Tori, Steve
Kimberly, Lisa
Ryan, Victoria
Linda, Jose
Keith, Elisa
Kellee, Janet
I
I
CA Municipality ENVIRONMENTAL UTILITIES 2296100222 M
I
M
M
M
I
I
I
I
I
I
I
I
I
I
I
I
M
I
CA Municipality POLICE
CA Municipality POLICE
CA Municipality LIBRARY
CA Municipality DEVELOPMENT SERVICES
CA Municipality POLICE
CA Municipality POLICE
CA Municipality Fire
CA Municipality PUBLIC WORKS
CA Municipality POLICE
CA Municipality Central Services
CA Municipality POLICE
CA Municipality Fire
CA Municipality POLICE
CA Municipality POLICE
CA Municipality LIBRARY
CA Municipality Central Services
CA Municipality Fire
CA Municipality Fire
CA Municipality POLICE
CA Municipality Fire
CA Municipality
CA Municipality Fire
CA Municipality POLICE
CA Municipality POLICE
CA Municipality POLICE
CA Municipality Fire
2196100064
2296100205
2296100206
2296100213
1696100046
2096100133
1696100083
2096100057
1996100116
1196100067
1596100089
1596100090
2096100043
1996100043
9096100051
9496100133
2296100010
1596100020
1996100032
1096100074
2296100220
2296100219
2296100216
2296100215
2296100185
1796100105
Kasey, LaDrea
Selene, Ryan
Roderick, Lea
Dolores, Vicente
Gabriela, Juan
Thomas, Binita
Angel-Lynn, McKenna
Devin, Jessica
Dinah, Elizabeth
Dolores, Cesar
Amber, Rosemarie
Angel, Krystal
Raul, David
Claudia, Alejandra
Lien, April
Tate, Frank
James, George
Demo - Smith, Carlos
David, Cynthia
Binita, Rosie
I
I
M
M
M
M
M
I
Cory, Erika
Cynthia, Michelle
Michelle, Candida
Amanda, Raul
Maximillian, Angelic
Candida, Neysa
12/2/2017
5/11/2022
180,506.70 Michelle D’Alessandro
9,375.00 Jessica LopezCA Municipality ECONOMIC DEVELOPMENT 2296100144 M Totals for None - 217 Claims
Totals for CA Municipality - 217 Claims
Grand Totals - 217 Claims

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

253

CA Municipality New Claim Log
Valued as of 11/30/2022
Level 1 Level 2 Claim Number Claimant Loss Date Type Of Claim Accepted, Delayed or Denied Open, Closed, or Re-Opened Total Incurred Net Adjuster User Employer: CA Munitipality
Type Of Claim: None
CA Municipality ENVIRONMENTAL UTILITIES 2296100222 Ana, Matthew Abigayl, Ruby
George, Patricia
Neysa, Angel-Lynn 10/10/2022
Crystal, Shirley 9/28/2022
Angelica, Roberto 10/27/2022
Jesse, Edgar
Arlita, Charlotte
Janet, Michael
Timothy, Cass
11/22/2022
11/24/2022
10/21/2022
M
M
M
M
M
M
M
M
I
A
A
A
A
A
A
Open
Open
Open
Open
Open
Open
Open
Open
Open
Open
1,000.00 Jessica Lopez

0.00 Jessica LopezCA Municipality Fire
CA Municipality POLICE
CA Municipality POLICE
CA Municipality Fire
CA Municipality
2296100223
2296100215
2296100216
2296100219
2296100220
2296100224
2296100221
2296100217
2296100218
2,175.00 Jessica Lopez
2,425.00 Jessica Lopez
2,500.00 Jessica Lopez
1,325.00 Jessica Lopez

0.00 Jessica Lopez
11,320.00 Stephanie Gonzales
6,268.08 Stephanie Gonzales
14,817.86 Stephanie Gonzales
CA Municipality POLICE
CA Municipality Fire
CA Municipality Fire
CA Municipality Fire
11/27/2022
4/7/2022
10/26/2022
10/29/2022
Y
A
AI
Totals for None - 10 Claims
Totals for CA Municipality - 10 Claims
Grand Totals - 10 Claims

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

254

Pool Client Claims Closed
Valued as of 12/12/2022
Claim Supervisor Adjuster User Claim Number Claimant Type Of Claim Future Medical? Loss Date Entry Date Date Closed Total Incurred 30,259.65
14,371.71
8,093.98
46,476.05
152,295.73
70,979.95
5,591.66
12,230.00
17,784.24
160,380.65
4,744.63

0.00 Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Sample Pool Supervisor 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 1
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 1
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 1
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 2
Adjuster 1
Adjuster 2
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 2
Adjuster 1
Adjuster 1
Adjuster 1
Adjuster 1
20080990234
20080990036
20080990003
20080990107
20080990075
20080990248
20080990028
20080990061
20080990037
20080990242
20080990241
20080990005
20080990041
20080990011
20080990344
20080990076
20080990010
20080990233
20080990201
20080990017
20080990016
20080990231
20080990032
20080990030
20080990132
20080990047
20080990155
20080990021
20080990012
20080990157
20080990367
20080990343
20080990131
20080990029
20080990027
20080990004
20080990156
20080990133
20080990039
20080990038
20080990048
20080990031
20080990040
20080990134
20080990264
20080990116
20080990009
20080990045
20080990303
20080990348
20080990209
20080990015
20080990169
20080990026
20080990035
20080990184
20080990263
20080990022
20080990208
20080990025
20080990020
20080990247
Claimant 1 Indemnity
Claimant 2 Indemnity
Claimant 3 Indemnity
Claimant 4 Indemnity
Claimant 5 Indemnity
Claimant 6 Indemnity
Claimant 7 Indemnity
Claimant 8 Indemnity
Claimant 9 Indemnity
Claimant 10 Indemnity
Claimant 11 Medical
Claimant 12 First Aid
Claimant 13 First Aid
Claimant 14 Indemnity
Claimant 15 Medical
Claimant 16 Indemnity
Claimant 17 Indemnity
Claimant 18 Indemnity
Claimant 19 Medical
Claimant 20 Indemnity
Claimant 21 Indemnity
Claimant 22 Medical
Claimant 23 Indemnity
Claimant 24 Medical
Claimant 25 Medical
Claimant 26 Medical
Claimant 27 Indemnity
Claimant 28 Medical
Claimant 29 First Aid
Claimant 30 Medical
Claimant 31 Medical
Claimant 32 Medical
Claimant 33 Medical
Claimant 34 Medical
Claimant 35 Medical
Claimant 36 First Aid
Claimant 37 First Aid
Claimant 38 Medical
Claimant 39 First Aid
Claimant 40 First Aid
Claimant 41 Medical
Claimant 42 First Aid
Claimant 43 Medical
Claimant 44 Medical
Claimant 45 First Aid
Claimant 46 First Aid
Claimant 47 First Aid
Claimant 48 Medical
Claimant 49 Medical
Claimant 50 Medical
Claimant 51 Medical
Claimant 52 First Aid
Claimant 53 Medical
Claimant 54 Medical
Claimant 55 Medical
Claimant 56 Medical
Claimant 57 First Aid
Claimant 58 Medical
Claimant 59 First Aid
Claimant 60 Medical
Claimant 61 Medical
Claimant 62 Medical
True 12/31/2017 1/30/2018 9/12/2022 1686
1415
1279
1095
1058
990
920
674
535
475
324
276
239
255
274
242
203
170
189
172
136
162
131
56 69
60 86
51 63
51 64
117
71 28
64 61
8 49
22 11
14 True
True
12/26/2018 1/3/2019
4/30/2019 5/1/2019
11/18/2022
10/31/2022
False
False
False
True
7/1/2019
6/5/2019
11/20/2019 11/19/2022
1/7/2020 11/30/2022
11/8/2019 1/14/2020 9/30/2022
10/4/2019 3/24/2020 9/30/2022
12/11/2020 1/25/2021 11/30/2022
4/15/2021 4/19/2021 10/6/2022
7/26/2021 8/12/2021 11/30/2022
10/17/2021 10/18/2021 9/7/2022
12/26/2021 12/28/2021 9/30/2022
1/12/2022 1/26/2022 9/22/2022
1/9/2022
1/28/2022 2/2/2022
1/5/2022 2/17/2022 10/17/2022
2/28/2022 3/3/2022 9/22/2022
3/18/2022 3/22/2022 9/8/2022
3/21/2022 3/22/2022 9/27/2022
5/11/2022 5/12/2022 10/31/2022
5/15/2022 5/17/2022 9/30/2022
5/20/2022 6/7/2022
4/11/2022 6/8/2022
6/30/2022 7/14/2022 9/8/2022
7/8/2022 7/14/2022 9/21/2022
7/14/2022 7/18/2022 9/16/2022
7/20/2022 7/25/2022 10/19/2022
7/20/2022 7/26/2022 9/15/2022
7/18/2022 7/28/2022 9/29/2022
11/11/2021 8/1/2022
7/27/2022 8/2/2022
4/1/2022
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False
False

33.59 1/28/2022 10/10/2022 3,890.83
17,481.30
11,381.67
7,033.77
27,028.58
2,664.28
2,467.89
13,837.90
1,534.63
13,736.13
721.12
534.54

0.00 2,437.27
843.69

2.00 6,743.19
1,418.24
344.29
799.47
457.84

4.00 0.00

0.00 1,560.16

0.00 0.00

48.21 0.00
279.51
583.05

0.00 0.00

0.00 309.72
481.62
925.70
1,850.00

0.00 179.83
195.90
356.12

38.61 11/3/2022
11/16/2022
10/17/2022
9/21/2022
10/5/2022
11/28/20228/3/2022
8/11/2022 8/16/2022 10/26/2022
8/16/2022 8/18/2022 9/15/2022
8/20/2022 8/23/2022 10/26/2022
8/15/2022 8/24/2022 10/24/2022
8/23/2022 8/25/2022 9/2/2022
9/4/2022
8/25/2022 9/8/2022
9/7/2022 10/26/2022
9/30/2022
9/7/2022
9/7/2022
9/8/2022
9/5/2022
9/8/2022
9/6/2022
9/13/2022 9/24/2022
9/13/2022 9/27/2022
9/14/2022 9/24/2022
9/14/2022 10/5/2022
9/15/2022 9/27/2022
9/15/2022 9/30/2022
10 21
12 15
8 10
30 26
31 14
14 19
19 15
15 6
9/21/2022 9/22/2022 9/30/2022
9/21/2022 9/26/2022 10/6/2022
6/30/2022 9/26/2022 10/26/2022
9/20/2022 9/28/2022 10/24/2022
9/26/2022 9/28/2022 10/29/2022
9/22/2022 10/5/2022 10/19/2022
10/1/2022 10/5/2022 10/19/2022
10/5/2022 10/6/2022 10/25/2022
9/30/2022 10/7/2022 10/26/2022
10/4/2022 10/11/2022 10/26/2022
10/7/2022 10/11/2022 10/26/2022
10/11/2022 10/13/2022 10/19/2022
10/8/2022 10/19/2022 11/28/2022
10/14/2022 10/21/2022 11/3/2022
10/19/2022 10/24/2022 11/8/2022
10/20/2022 10/27/2022 11/22/2022
8/30/2022 11/4/2022 11/29/2022

0.00 0.00

0.00 295.82

38.61 40
13 15
26 25 0.00

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

255

CA Municipality (WC)
Claim Log - Work Status
Jan - October 2022
Claimant Claim No. Date of Loss Work Status Date Effective Days in Work Status Result/Nature Description Target/Part of Body Description Date of MMI (Max Improvement) Camesha, Anna
Edgar, Brianne
Lauren, Lauren
Charlotte, Nancy
Kelsey, Norma
20080990328
20080990317
20080990290
20080990316
20080990278
06/23/2022
12/26/2020
03/22/2022
05/14/2022
10/07/2021

RESTRICTED-NTL

OFF WORK
06/24/2022
12/27/2020
04/29/2022
05/15/2022
10/08/2021
115 Strain or Tear Finger(s)
659 All Other Cumulative Injury
171 Strain or Tear
Multiple Body Parts
Multiple Upper Extremities
Brain

OFF WORK
OFF WORK 155 All Other Cumulative Injury
374 All Other Cumulative InjuryOFF WORK Circulatory System Lisa, Karen 20080990362 09/09/2022 OFF WORK 09/10/2022 37 All Other (Specific) Injuries, NOC Multiple Body Parts Total Claim Count - 6

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

256

Senior Management Bios
Judy Adlam, who serves as our President and CEO, owns LWP. JudyJudy Adlam joined LWP in 1998 following a 22-year career at Fireman’s Fund.

During that time Judy held a progression of technical and executive positions in claims, human resources and training, eventually serving as Vice-President - Worker’s Compensation Claims. In that capacity she was responsible for nationwide claims handling strategy and quality. In her current capacity at LWP, she creates the company vision by facilitating an environment of teamwork and excellence. She is a recognized industry leader in Workers’ Compensation claims management with a reputation for integrity, quality services and innovation. She is a Chartered Property Casualty Underwriter (CPCU) and a Senior Claims Law Associate (AEI). She earned BA degrees in both Psychology and Sociology at California State University at Northridge, and served six years’ (2007-2013) service on the Board of Directors of the Insurance Education Association (IEA), including two terms as Chair.

President and CEO
Brian joined LWP in 2013 as Vice President - Claims after 11 years at a national TPA, where he was responsible for management and claim operational oversight of 4 California claim locations. He has 27 yearsof industry experience at both large and small third party claims administrators, insurance companies and an insurance broker. Brian has extensive experience managing claims for self-insured employers (both public and private), clients with alternative risk arrangements and fully insured employers and their carriers. At LWP, Brian leads the claims adjusting efforts, with responsibility for client services and the quality and productivity of our adjusting staff. He is a graduate of the University of California at Santa Barbara and currently holds his WCCA, WCCP, California Self Insured, and General Insurance certificates. He is a Certified Adjuster under the California Insurance Code and the California Code of Regulations.

Brian Esparza
VP - Claims

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

257

DAWN SORA MOORE, RN, MSN, CCM
Senior Director - Utilization Management

SUMMARY OF EXPERIENCE
Dawn has 29 years in the Managed Care operations space. Her leadership roles encompass utilization review, telephonic case management and field case management. She has experience in all lines of insurance, including Short- & Long-Term Disability, Auto Liability and Workers’ Compensation. Dawn is responsible for all aspects of the operations ensuring financial success within the region, delivering customer excellence across all programs, working closely with customers and communicating outcomes, program trends and opportunities for program enhancements.

WORK HISTORY
Mitchell Genex Coventry- Irvine, CA
Senior Director, Utilization Management October 2021- Present  Oversee close to 200 employees including Managers, Supervisors, Leads, Case Managers and Intake staff


Responsible for managing all operational components for my business region Responsible for customer excellence delivery for various Telephonic Case Management (TCM) programs servicing in various TCM models (onsite, work at home and remotely from an office) Recently promoted with larger financial responsibilities within my team and the company enterprise

 Responsible for delivery in partnership with Information Management and Account Management customer outcomes, trends, results and financial success Genex Services, LLC - Anaheim, CA
Director, Utilization Management January 2000-October 2021 

Full responsibility of case management operations
Closely work with my peers within product, legal, sales, marketing, quality, information management and account management with various program initiatives on my team and for larger opportunities for the company enterprise
 Connect with our clients proactively sharing trends and recommendations to ensure program success
Intracorp – Dallas TX, Seattle WA, Honolulu HI, Atlanta GA and all California TCM/FCM Branch Manager, Program Manager December 1996-2000 


Responsible for Telephonic, Field and Utilization Review Management within my various roles as a Branch Manager
Experience managing programs with remote and onsite employees within various national Employers, Third Party Administrators within our book of business.

Responsible for all quality management oversight ensuring customer delivery excellence Page | 1

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

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Telephonic Case Manager, Utilization Review December 1994- 1996 

Manage Workers’ Compensation TCM cases
Manage Utilization Review cases
Baylor Medical Center, Parkland Memorial Hospital- Dallas TX Registered Nurse Cardiothoracic ICU, Emergency Room, Operation Room, Diabetic Teaching 1992-2000

EDUCATION, CERTIFICATIONS & LICENSES



Certified Case Management (CCM)
Baylor University- Master of Science in Nursing (MSN)
University of Tulsa/Wichita State University- Bachelor of Science in Nursing (BSN) Page | 2

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

259

Sandra Corradi, CPC
Director of Operations
Job Description
Manage daily operational workflow, including production, quality assurance, bill aging, and client satisfaction. Assist compliance team with state fee schedule guidelines and rule rules. Ensure that client turnaround and handling guidelines are adhering to SLAs and accūrō Solutions’ standards. •
•
Management of daily bill auditing workflow, including reconsiderations, review only and lien resolution.

Quality assurance of complex workers’ compensation provider, pharmacy, DME, and hospital claims in accordance with jurisdictional and client specific guidelines.

Assist compliance department with testing of state fee schedule and rules updates.

Consistently meet established performance standards, including quantity and quality claims review standards.
•
•
•
•
Manage high priority Rush/Appeals/Special handling requests.

Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the managing auditing of auditing, customer service, and all other job functions.

Maintain CPC Certification
Handle complex reconsiderations, communicate reconsiderations with PPO networks.

Coordinate state filing appeals and responses.
•
•
•
Employment History
December 2004 to July 31, 2021
CareWorks (formerly MCMC)
Director of Bill Review
• Managed of a team 30 medical bill auditors and support staff for an operation processing over 1.2 million bills annually.
•
•
•
Provided sales and account management support.

Assisted in system and workflow designs for proprietary medical bill review applications.

Assisted with development and testing of state fee schedule and rules updates.

October 1995 to November 2004
Regional Business Manager
Concentra Managed Care (formerly National Healthcare Resources/Options) • Managed of a team 15 medical bill auditors and support staff for a regional medical bill review business.
•
•
Provided sales and account management support
Assisted with testing of state fee schedule and rules updates.

January 1986 to June 1995
Travelers Insurance
Processing of health insurance divisions claims. Transitioned to Case Installations working with sales, coding the accounts.
accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

260

Courtney Kern
Medical Bill Auditor I
Job Description
Quality control review and / or error correction and final adjudication of paper and electronic workers’ compensation medical and expense bills. Determines whether to return, deny or pay bills following organizational policies and procedures. Provide customer service, including communicating information to hospitals, physicians and client representatives regarding reimbursement and claims status.
•
•
•
•
•
Review routine workers’ compensation physical therapy, pharmacy, DME, and expense bills in accordance with jurisdictional and client specific guidelines.

Resolve claim edits, verify client-specific rules, and review history records and determine eligibility for payment.

Consistently meet established performance standards, including quantity and quality claims review standards.

Provide customer service by responding to and documenting telephone and/or written inquiries.

Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the payment of claims, customer service, and all other job functions.

Consistently demonstrate excellent attendance and punctuality.

Meets all production and quality standards. Attends all required training classes.

Elevate issues to next level of supervision, as appropriate. •
•
•
Employment History
2020 to 2021
Wellness Pittsburgh – Medical Coding & Billing Specialist Transcribe procedures and diagnosis into universal medical codes. Review patient charts to determine medical history, including previous diagnosis and treatments. Review codes to submit claims to insurance companies. Provide front office administrative assistance to incoming patients Maintain office continuity in absence of the principal 2016 – 2021
PNC Financial – Universal Financial Consultant
Responsible for strengthening customer relationships with a defined sales process. Personal banking, engaging customers in high value conversations to unleash a deep financial picture for clients in order to present financial solutions. Lead by example in applying product and procedural knowledge to identify, mitigate and solve customer problems effectively to drive customer loyalty. accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

261

Elissa Wolfe
Medical Bill Auditor II
Job Description
Quality control review and / or error correction and final adjudication of paper and electronic workers’ compensation medical bills. Determines whether to return, deny or pay bills following organizational policies and procedures. Provide customer service, including communicating information to hospitals, physicians and client representatives regarding reimbursement and claims status.
•
•
•
•
•
Review complex workers’ compensation provider, pharmacy, DME, and hospital claims in accordance with jurisdictional and client specific guidelines.

Resolve claim edits, verify client-specific rules, and review history records and determine eligibility for payment.

Consistently meet established performance standards, including quantity and quality claims review standards.

Provide customer service by responding to and documenting telephone and/or written inquiries.

Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the payment of claims, customer service, and all other job functions.

Consistently demonstrate excellent attendance and punctuality.

Meets all production and quality standards. Attends all required training classes.

Elevate issues to next level of supervision, as appropriate. •
•
•
Employment History
1999 to 2021
Cost Containment Solutions, MCMC, CareWorks
•
•
CA Certified
Compliance to OMFS – multiple jurisdictions
•
•
•
•
•
Ability to run and distribute reports
Medical Legal Review
Quality Assurance
Client Service
Ability to correctly interpret
contract language
• CA Certified Accountable for the entire LWP
account
•
•
Provider Inquiries
Represented employer at on site location as
liaison to TPA
1999 to 2009
Cost Containment Solutions – Receptionist/Medical Bill Review Analyst •
•
•
Review of CA workers’ compensation medical bills
Client customer service
Provider inquiries
accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

262

Jeizzell Misipati
Medical Bill Auditor I
Job Description
Quality control review and / or error correction and final adjudication of paper and electronic workers’ compensation medical and expense bills. Determines whether to return, deny or pay bills following organizational policies and procedures. Provide customer service, including communicating information to hospitals, physicians and client representatives regarding reimbursement and claims status.
•
•
•
•
•
Review routine workers’ compensation physical therapy, pharmacy, DME, and expense bills in accordance with jurisdictional and client specific guidelines.

Resolve claim edits, verify client-specific rules, and review history records and determine eligibility for payment.

Consistently meet established performance standards, including quantity and quality claims review standards.

Provide customer service by responding to and documenting telephone and/or written inquiries.

Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the payment of claims, customer service, and all other job functions.

Consistently demonstrate excellent attendance and punctuality.

Meets all production and quality standards. Attends all required training classes.

Elevate issues to next level of supervision, as appropriate. •
•
•
Employment History
2016 to 2021
Orem Junior High- Orem, UT
•
•
Maintain office continuity in absence of the principal
Oversees the work activities within the office for the purpose of organizing assignments and ensuring completion within established guidelines.

Establishes and maintains records
Compiles and distributes materials and reports within assigned programs Responds to inquiries from a variety of internal and external sources Gathers and inputs any payroll related forms
Schedules/ coordinates activities
Maintains inventory of supplies and materials
Maintains accurate attendance records and reports
Monitors the release of student’s to authorized parent and/or guardian Translator
•
•
•
•
•
•
•
•
•
accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

263

Veronica Alvarado (Veronica)
Medical Bill Auditor II
Job Description
Quality control review and / or error correction and final adjudication of paper and electronic workers’ compensation medical bills. Determines whether to return, deny or pay bills following organizational policies and procedures. Provide customer service, including communicating information to hospitals, physicians and client representatives regarding reimbursement and claims status.
•
•
•
•
•
Review complex workers’ compensation provider, pharmacy, DME, and hospital claims in accordance with jurisdictional and client specific guidelines.

Resolve claim edits, verify client-specific rules, and review history records and determine eligibility for payment.

Consistently meet established performance standards, including quantity and quality claims review standards.

Provide customer service by responding to and documenting telephone and/or written inquiries.

Maintain current knowledge of jurisdictional guidelines and effectively apply knowledge in the payment of claims, customer service, and all other job functions.

Consistently demonstrate excellent attendance and punctuality.

Meets all production and quality standards. Attends all required training classes.

Elevate issues to next level of supervision, as appropriate. •
•
•
Employment History
September 1999 to present
Cost Containment Solutions, MCMC, CareWorks – Senior Medical Bill Review Analyst •
•
CA Certified
Compliance to OMFS – multiple jurisdictions
CA Certified Accountable for the entire LWP
account
Provider Inquiries
Represented employer at on site location as
liaison to TPA
•
•
•
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•
Ability to run and distribute reports
Medical Legal Review
Quality Assurance
Client Service
Ability to correctly interpret
contract language
•
•
•
1991 to 1999
Hertz Claim Management – Senior Claims Assistant- IEA Certified •
•
•
Assist Claims examiner with daily claims adjudication
Send out benefit letters
Paid TTD benefits and medical bills
1990 to 1991
Alexis Risk Management – Claims Assistant
accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

6.10 Attachment 3 - LWP Claims Solutions, Inc. Response to Request for Proposal

264

C
ost Proposal – City of Foster City
P age 1
S ubmission Date – April 10, 2025

7. C
ost Proposal Cost Proposal Based on your understanding and recommendations, Respondent shall submit a fixed- price cost proposal reflecting a bottom -line price to deliver all the services requested under this solicitation for the three -year duration of the Agreement. The fixed costs shall be inclusive of all costs and materials for preparing the scope of service. No payment will be made for any other expense or cost. Respondent shall provide sufficient detail/description in its cost proposal for the City to evaluate the overall quality of the proposed service.

W
e would be happy to discuss one bottom -line price, but do not recommend that approach. LWP suggests one fee for all claims adjusting, but separate charges for ancillary services, including b ill re
view, Utilization Review, Nurse Case Management and invest igations. LWP utilizes those services so infrequently that we believe any bottom -line estimate will actually cost the City more than our recommended approach.

Claims Administration - Life of Contract Claims Administration and Managed Care Option 1 - New Claims Only
Indemnity $500 per claim (set-up fee, including 1st month of handling) + $125 per month/per open indemnity
claim
Monthly fee reduced to $75 per month once claim
becomes “Future Medical” (after Permanent
Disability is resolved)
Medical Only Claims $275 per claim (one time fee)
First Aid Claim $50 per claim (one-time fee)
Option 2 - Including New and Takeover Claims
7/1/2025 - 6/30/2026 $79,000
7/1/2026 - 6/30/2027 $81,370
7/1/2027 - 6/30/2028 $83,811
Services billed monthly at 1/12 of annual cost
Fees assume use of LWP Cost Containment/Managed Care Services Services Included in Claims Administration Fee
Claims Administration Designated Account Manager
Claim Review Meetings Litigation Management
Reporting to Excess Carrier
Notes:

6.10 Attachment 4 - LWP Claims Solutions, Inc. Cost Proposal

265

C
ost Proposal – City of Foster City
P age 2
S ubmission Date – April 10, 2025
• Set up fee is charged in the first month of LWP’s handling. • Monthly fee for indemnity claims will convert to the lower Future Medical fee in the month following final approval of resolution of permanent disability.

Annual Administration Fee
Annual Administration Fee $2,000
Bank Charges (one account) Included
Does not include outgoing ACH Payments
Storage Fees Included
On-Line 5020 Reporting Included
Loss Reports Included
On-L ine System Access 4 users included ($250 per user-year for additional users)
Trust Accounting Included
Preparation and filing of 1099's Included
FROI/SROI Reporting Included
Medicare Reporting Included
Cost Containment and Managed Care Services
Medical Bill Review Fee
Standard Medical Bill Review Fee Schedule
Reductions $9.00 per bill plus PPO Reduction
I npatient hospital and Ambulatory Surgery
Center
$400 per bill plus PPO Reduction if original charges
are greater than $300
PPO Reduction 24% of Reduction below Fee Schedule
27% Anthem Only
Bills not subject to Fee Schedule 24% of Reduction
File Indexing
Index and OFAC Reporting (ISO Fee passed
through) $22.50 per claim
Rate adjusted annually
E-Bill
E-B ill Fees $2.00 per bill submitted by a provider through a clearinghouse
Case Management

6.10 Attachment 4 - LWP Claims Solutions, Inc. Cost Proposal

266

C
ost Proposal – City of Foster City
P age 3
S ubmission Date – April 10, 2025
Telephonic Case Management $104 per hour
F ield Case Management $110 per hour + incidentals (including mileage, phone, tolls, parking, etc.)
Utilization Review
Adjuster Review No Charge
Tier 1 - Nurse Review $120 Flat Fee
Includes 3 medical request in a single review, set up, phone calls to physician, email notices to adjuster and letters to all parties including network providers. Fee applies to reviews approved by nurse or escalated to physician.

Tier 2 - Physician Review $235 plus nurse charge
Includes 3 medical request in a single review.

Reconsideration: $235 flat fee (up to 3 medical requests per referral) P harmacy Review $385 plus nurse charge
Includes unlimited medical request in a single review.

Reconsideration: $385 flat fee
Medical Provider Network Access (LWP Network)
PPO fee for savings below fee schedule and negotiations 24% There is no separate charge for medical provider access to LWP's proprietary network. Percentage of savings below fee schedule is the only charge.

Specialized Network Access (bill review charges do not apply) Durable Medical Goods $5 per bill network access fee
Expedited Diagnostic Testing $5 per bill network access fee Physical Therapy Network $5 per bill network access fee Pharmacy Network $5 per bill network access fee
These charges apply only if LWP's programs are utilized.

Investigation
Investigation
Investigative Services $95 per hour
SIU Related Services $105 per hour
Background Investigation $375 flat rate
Social Medial Investigation $375 flat rate
Background + Social Media at Discount $550 flat rate
Medical Canvass $525 flat rate
VeriFive Package of 5 services for claim verification at $800+ Discount
$1,550 flat rate
VeriFive Package includes 1. Background; 2. Social Media; 3. Medical Canvass; PLUS 4. SIU Review + Strategy Development; and 5. Recorded Virtual Statements inclusive of Evidence-Based Questions. Includes two statements; additional fees apply for add-on services.

6.10 Attachment 4 - LWP Claims Solutions, Inc. Cost Proposal

267

Cost Proposal – City of Foster City

Page 4 ends

Foster City City CouncilJune 16, 2025

Foster City City Council
June 16, 2025