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

R
esponse to RFP – City of Foster City
P age 1
S ubmission Date – April 10, 2025
LWP Claims Solutions, Inc
Workers’
Workers’ Compensation Claims Management
City of Foster City
Response to Request for Proposal
J
udy Adlam
President and CEO
April 10, 2025
Delivering
What We Promise
[email protected] | 35 Miller Ave #214 Mill Valley, CA 94941 | 415-384-0370 R
esponse to RFP – City of Foster City
P age 2
S ubmission Date – April 10, 2025
City of Foster City April 10,2025
Submitted via email to [email protected]
R
e: City of Foster City Request for Proposal Workers’ Compensation Third Party Administrator Thank you for the opportunity to propose Workers’ Compensation claims services for the City of Foster City’s Workers’ Compensation program. We are very interested in the opportunity to control your claims costs while properly supporting your employees. Our extensive experience supporting cities who both newly join pools as well as those who leave pools gives us a depth of understanding of the changes you will experience. We believe that this perspective coupled with our focus on sound best practices and ou r track record for building very productive relationships makes us uniquely qualified to support your needs.

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:

Municipal Pool Client- A new client to us in 2013, they had 374 open indemnity claims at time of transfer from their prior TPA. The client was hoping to see this reduced below 350, with a reduction in outstanding loss reserves, as well. At the same time, there were service challenges they hoped to resolve. At the end of 2014, LWP had successfully reduced the open claim inventory to 302 claims (far lower than the client thought was possible) and had reduced the outstanding claim reserves by more than $1.5 million. At the end of 2019, their open inventory was 292 with outstanding claim reserves down another $1 million. Current outstanding reserves are now more than $3Mil lower than upon takeover.

Municipal Pool Client- New to LWP in 2016. We have assisted that pool in reducing their claims costs while streamlining services for their members. We have assisted them in sales presentations that resulted in adding new members. Upon their merger with another pool, they conducted a 1 year evaluation of their two TPAs and ultimately decided to move the merged members to LWP, based on their evaluation of our claims and expense management and service feedback.

Self-Insured Client- Upon transfer of claims from the prior TPA, LWP recognized that there had been lapses in attention to Excess reimbursement requests. LWP wrote a simple letter to the excess carrier that resulted in $800,000 in recoveries of past-due excess reimbursements.

Municipality Client – New to LWP in early 2015, within 7 months, total outstanding pending claim volume had been reduced by 16%, with corresponding reductions in outstanding reserves. Additionally, several future medical claims had very significant course corrections, result ing in very substantial reductions in medical and

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

S
hould 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.

L
WP 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.

I
n 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) S
tart 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 L
WP 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!” W
e look forward to hearing about next steps.

S
incerely,
Ju
dy Adlam
President & CEO
LWP Claims Solutions, Inc.
35 Miller Ave. #214
Mill Valley, CA 94941
(415) 73
0-7841 (cell)
[email protected]

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Submission Date – April 10, 2025
Table of Contents

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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Submission Date – April 10, 2025

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:
 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.

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

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

I
n 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:

C
ity 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
P
RISM PWC Members
• C
ounty of Sutter
• City of Carmel-by-the-Sea
• C
ity of Lindsay
• Mt. Diablo Unified School District
• Tahoe Transportation District
• San Mateo Consolidated Fire District
Y
CPARMIA Members
• C
ounty 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
• Esparto Fire Protection District
• In-Home Supportive Services Public
Authority
• 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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esponse to RFP – City of Foster City
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• Valley Clean Energy Alliance
• Yolo County Habitat Conservation
• Yolo County Law Library
• Yolo County Local Agency Formation
Commission
• Yolo County Superior Court
• Yolo Emergency Communications
Agency
• Yolo-Solano Air Quality Management
District
C
IRA Members
• C
ity of Alturas
• City of Arcata
• C
ity of Avalon
• City of Belvedere
• City of Blue Lake
• City of Calimesa
• C
ity of Calistoga
• City of Citrus Heights
• City of Clearlake
• City of Cloverdale
• City of Coalinga
• C
ity of Cotati
• C
ity of Eureka
• C
ity of Ferndale
• City of Fort Bragg
• City of Fortuna
• C
ity 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
• C
ity of Rancho Cucamonga
• City of Rancho Santa Margarita
• City of Ridgecrest
• City of Rio Dell
• City of Rohnert Park
• City of Sebastopol
• C
ity of Sierra Madre
• City of Sonoma
• C
ity of St. Helena
• C
ity of Tehama
• C
ity of Trinidad
• City of Twentynine Palms
• City of Ukiah
• City of Upland
• City of West Hollywood
• City of Wheatland
• City of Wildomar
• C
ity of Willits
• City of Yucaipa
• C
ONFIRE
• Rancho Cucamonga Fire Protection
District
• Town of Truckee
• T
own of Windsor
• Town of Yountville
• Town of Yucca Valley
N
CCSIF (Northern CA Cities Self-Insurance Fund)
• C
ity of Anderson
• City of Auburn
• City of Colusa
• City of Corning
• City of Dixon
• C ity of Elk Grove
• City of Folsom
• City of Galt
• City of Gridley
• City of Ione
• City of Jackson
• City of Lincoln

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Submission Date – April 10, 2025
• City of Marysville
• City of Nevada City
• City of Oroville
• City of Placerville
• City of Red Bluff
• 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
• 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 R
esponse to RFP – City of Foster City
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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 be tter 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.

Response to RFP – City of Foster City

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Submission Date – April 10, 2025

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 Sa cramento, 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:
• “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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esponse to RFP – City of Foster City
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I
n 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.

W
e 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. D
escribe 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).

L
WP 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.

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

5. S
ubmit 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
W
e offer the following references for whom we continue to provide services similar to those requested by the City;
C
ity of Fremont
Steve Schwarz
Risk Manager
3300 Capitol Ave.

Fremont, CA 94538
(510)
28 4-4052
[email protected]
C
ity of San Mateo
Yuliya Shukhat
Sr. Risk Management Analyst
330 West 20th Ave.

San Mateo, CA 94403
(650)
52 2-7263
[email protected]
C
ity of Burlingame

Response to RFP – City of Foster City

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Submission Date – April 10, 2025
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 t he 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  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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Submission Date – April 10, 2025
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. Each supervisor oversees the work of 3 -5 Examiners.

Supervisors do not carry caseloads at LWP.

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, having 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.

Amber Davis
Director of Claims
Public Entities

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Submission Date – April 10, 2025
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 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 Man ager 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.

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.

Stacey Bean
Assistant Manager

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Submission Date – April 10, 2025

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

Response to RFP – City of Foster City

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Submission Date – April 10, 2025
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 program s) as well as to the billing and results reporting.

Our Recommended Partners should the City choose to review them are;

Proprietary MPN Signature Networks Plus Bill Review accūrō Solutions Utilization Review Genex Case Management 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 an d 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, bu ilt 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.

Signature
Networks Plus accuro Genex
Managed Care Optum One Call HomeLink

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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- Optum
Durable Medical Goods- One Call Medical and HomeLink Translation and Transportation- One Call Medical and HomeLink Expedited Diagnostic Testing One Call Medical and Homelink Physical Therapy Network- 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 serv ed 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 gene ralist 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 s ervice 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, po st-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 (S IP) 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 prospec ts 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.

Amber Davis
Director of Claims
Public Entities
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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 Ma nager 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.

LW
P 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 C
laims 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:
 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) 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:
 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)
Can
didate must also successfully pass LWP’s background checks (credit and criminal).

4. Pr
ovide 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 Stacey Bean
Assistant Manager

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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 identi fy 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 delive r 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
• 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 considerati on, 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 w ith the City of Foster City to accomplish the following:
• G
ain 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)
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)
• 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 averag e. 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:
• 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 o f 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 incl uded 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 c lient. 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;

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 Indemnity Claim Timeline

CLAIM REPORTED
TO LWP

SUPERVISOR

REVIEWS AND

ASSIGNS CLAIM
3 POINT CONTACT
MADE

INITIAL RESERVES
SET

PLAN OF ACTION

CREATED

SUPERVISOR
REVIEW

FIRST CASE

RESOLUTION
DIARY

PLAN OF ACTION

REVIEWED

SUPERVISOR
REVIEW

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

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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 dia ry. 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 “Wh en 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 assig nments 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:
• 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 the se 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 in jured 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.)

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 requ irements, 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.

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

W
e 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:
 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,
 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!
W
e 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.

W
hile 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.

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:
 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
 OSHA 300 and 300A
 Check Registers
 Individual Claim Reports (Notes, reserve activity, plan of action, etc.)

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Subm ission Date – April 10, 2025
St
andard reports templates allow user to specify:
 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. Co
st 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 investi gations. LWP utilizes those services so infrequently that we believe any bottom-line estimate will actually cost the City more than our recommended approach.

• 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 • 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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esponse to Scope of Services – City of Foster City
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S ubmission Date – April 10, 2025
T
his 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 w ill
e
nsure 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 b y
re
quiring 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 acti on 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 o f h
andling, 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 mist rust lead to unnecessary litigation and expense.

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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 ab out 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.
 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 i njured 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

 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

 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

 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.
 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

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  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
 Provides transparency
 Streamlines processes
 Empowers Injured Workers

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 Identifies claim risks in real time

Key Features of LWP CareConnect
 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 r eleases 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 f or 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 issu es 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 sig nificantly increases the likelihood of a successful outcome. We are committed to:
 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.

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.

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 i mmediately 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 a ppropriate, 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 carri er, 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 ha ve 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 M edicare 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 s uch 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 R
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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.

O
ur 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. C
onsultant 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’ Compensatio n
be
nefits 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.

L
WP 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 bankin g a
rrangements at any �me.

W
e 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.

L
WP takes very seriously our responsibly for ﬁnancial integrity. Among the many ac�ons we take to ensure quality and ﬁscal integrity are:
▪ R
econcilia�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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esponse to Scope of Services – City of Foster City
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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. C
onsultant 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 jo b
di
splacement benefits and loss adjustment expenses.

LWP maintains very robust reporting capabilities. We deliver reports via several methods:
 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 a schedule determined by you. Additionally, we will take our direction from you as to which reports to provide to each department. The menu of reports available includes:
 C
umulative 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)

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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:
 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 will 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. 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:
 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 all ow 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 e xaminer 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 inv estigate 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 disclosur es 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

Claims Best Practices
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

Claims Best Practices
LWP Claims Solutions – updated March 2023 Page 2

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 “f it” with the client. Clients are always invited to interview our staff prior to assignment. Additionally, we will remove an y 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:
 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)
 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
 Phase 5- Candidates that pass Phase 4 will interv iew 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 developm ent of our staff is critical to the success of our operation. LWP goes well beyond meet ing 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 ou r 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 exce ptional an examiner’s performance might be, they cannot be promoted without completing industry designations, includi ng the Self-Insurance Certification. LWP requires this Claims Best Practices
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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 qualif ied to pinch-hit and step in to assist other Examiners. All staff and management are fully trained in the rules a nd 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 qua ntifiable objectives, and qualitative narrative comments on exceptions
 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 w ill 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:
 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 ar e 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:
 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 di aries 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 t o 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 lif e 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 s upervisor’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 pr actices 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 de gree of communications with employers and clients. To that end, we feel that it is very important to involve our client s 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 issu es. We strongly believe that the client’s input is essential to effective case resolution. LWP will establish a claim re view 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 th e 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.

A client will never hear “they shouldn’t have promised that”, or “I don’t know why they di dn’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.

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 ti me 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 ex aminers will conduct the more extensive case evaluations that indemnity claims require. The evaluation will include all the following items:
 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 recommendati ons for specific issues to consider during the initial investigation. We require supervisors to approve any claim de lay 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 employ er) whether the claim will ultimately be accepted, or will be denied.

We recognize that claim investigation is critical to de termining issues of employment, compensability, benefits, subrogation and safety hazards or violations. Claim investig ation 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 indi cators that a field investigat ion and face-to-face statement taken from the injured worker may be indicated. Those criteria include:

 Vehicle accident
 Other than employer’s premises (slip and fall, water hazard, damaged walkways, sidewalks, etc.)  Machinery or equipment failure
 Assault (human or animal)

 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

 Monday morning report of a Friday injury
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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
 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.
 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
If the examiner recommends delay a claim for additional invest igation, the client will be notified of the basis for the delay and the actions the examiner will take to promptly comp lete 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 co mmunications 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 ca n expect increases the likelihood of a successful outcome significantly. We are committed to:
 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 de signated 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 recogniz e 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 “a ccuracy”, 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 cale ndar 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 re serves represent the probable ultimate outcome based on available information.

Examiners and supervisors are assigned a reserve authority ba sed 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 identi fying cases that need to be reported to the employer, carrier, excess carrier, and other pertinent parties.

Our clients can set thresholds for reserve authority and report ing. 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 freque ntly 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 Orig ami’s built-in Reserve Change Worksheet unless the client has developed and designated the use of an alternate work sheet. In those cases, the use of an al ternate 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 outcom es, 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 manage ment 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 specif ic activities, the examiner ensures that time is not wasted, and the claim continues to move toward resolution. The examin er will set the action diary for the next milestone that is expected (ie. medical appointment, hearing, etc.). The ex aminer 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 trigge rs, at intervals no longer than 60 days, the Examiner updates the Case Resolution plan to ensure that we are focused on re solving 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!

Diary function used for communications with support staff

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Our diary system is also used to route work between exam iners 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 s upervisors 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 safeguar d to the claims management process. Those features include:
 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 mana ger 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 pr oprietary 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, et c.), outline pertinent factors and document the actions taken to resolve the issue. The diary system allows the examin er 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 reso lution 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 ex ample) is no different from the ability to climb stairs at work.

Upon receipt of modified or full duty release, the employ er 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 assi st in facilitating return to work. Possibl e steps include (not necessarily in this order):
 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 philo sophy 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 ar e achieved through a multi-pronged approach to Medical Management:
 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 Utilizatio n 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 (i f 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 wi th our internal guidelines and any guidelines set by our clients.

UR Guidelines:

Examiners are encouraged to use the UR services at an y time that they have questions or concerns about requested treatment. In the absence of specific concer ns, though, our Examiners ar e 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
· 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
· 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 trea tment requests, our experien ce has proven that less than 30% of treatment requests that are sent to UR ar e approved at the nurse level. More than 70% of our referrals are escalated to the physician level and do resu lt in treatment modificati ons 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:

· 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 procedur es 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
· 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 basi s. 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 imme diate 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 Mana ger at any time, we use their assistance very sparingly.

Situations that might warrant consideration of a nurse referral include:
 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 manage r. 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 So lutions, is flexible and can be adapted to meet the unique needs of each client. We offer a menu of services that are focused on sp eeding claim closures while reducing claim costs. Each service can be customized for each client. Our current programs include:

 Access to multiple PPO & MPN networks
o Ability to wrap PPO networks for increased cost savings o 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 appr ove initial and straightforward procedures to streamline medical treatment and reduce UR costs for employer o Integration of Utilization Review Results into the Bill Review System o Increased flexibility to perform & track adjuster UR approvals o Paperless solution to allow real time access to all medical information

 Superior expertise and results in telephonic & field case management o Focus on task assignments to contain costs and focus on high-impact services o Specialized field case managers for large claims
o Dedicated nurses to facilitate communication with adjuster & client o 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 fa ce 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 eith er 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 acc ūrō 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:
 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
Additionally, a Supervisor must release each payment individually if they are caught in the queues based on:
 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 auto mated 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.

If the employer cannot permanently accommodate the empl oyee, the examiner will contact the injured worker to explain the benefit and act as a resource for the injure d employee. This allows the examiner to discuss the Claims Best Practices
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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 complia nce 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 ra te. 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 w ill 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 ou r 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 firm s 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 defe nse counsel. We will document the client’s preferences in their customized special claims handling guidelines to be us ed 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 seriousl y. We utilize a list of Key Fraud Indicators that assist the examiner in identifying claims that may require additi onal 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 facilitat e our Special Investigations Unit (SIU). In the event an examiner finds suspicious activity by any party to a worker s’ 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 filin g 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 disa bility 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 th e 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 physi cian that will result in the physician releasing the injured w o r k e r t o r e t u r n t o m o d i f i e d o r f u l l d u t y . F i l m s t h a t s h o w s o m e m o d e r a t e a c t i v i t y c a n b e v e r y s u c c e s s f u l l y u s e d t o 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:

 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 re cognition that an existing lo ss has developed large loss characteristics, the following procedures are followed:

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 Upon receipt of a new loss meeting the large loss report ing requirements, LWP’s new loss coordinator will send an email alert to the claims examiner, clai ms supervisor, claims manager and vice president in a format outlined in our Large Loss Program.
 Immediately, but no later than one hour after receiving noti ce 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 co ntinued reporting to applicable parties in accordance with any client/excess carrier guidelines.
 The Claims Examiner retains ultimate responsibility for time ly 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 subrog ation, 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 th e types of claims and circumstances that are likely to have subrogation potential such as premises (i.e. slip-and-fa ll 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 inve stigation 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 inte rfere with our clients’ relationships with their suppliers, vendors, partners, customers and landlords. For cases wher e 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 wo rk 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 electron ic 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 Claims Best Practices
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recommendation for the appropriate settlement vehicle and amo unt. 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 ex aminer’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 in ternal 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 (dep ending 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 rati onale 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 i ssue, 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 partic ular 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 he aring 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 previous ly involved a defense attorney. For a nominal fee, they hand deliver settlement documents to a judge and wait for th e 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 ou r 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 ex isting claim, the new information is presented to the examiner Claims Best Practices
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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 cl aims supervisor, who will convert the “incident” to a “claim”, assign the claim to the appropriate examiner and provide de tailed 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 wa s originally received by the office, whichever comes first.

Medical treatment requests must be handled within one busine ss 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 (consi stent 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 Exam iner 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 applic able PPO discounts so that the client achieves the best possible cost savings.

Once the examiner has approved the medical bill and/or ve ndor bill and any appropriate discounts are applied, the payment is processed. LWP utilizes an automated bill paymen t 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 in formation 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 st atement 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 fo urteen days from the date of first disability (with medical certification) and knowledge of injury. As such, our paym ent 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 support ed 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 cl aim 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 acco unt set up to meet the specific requirements of each client. The client may select the bank, or LWP will re commend 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 incl ude a check register and invoice. Requests will be made at the close of each month provided the account has sufficien t 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 al low 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 Claims Best Practices
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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:

 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:

 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. Ba nk reconciliation will be completed and delivered within 30 days of the close of each month.

Escheat Quarterly, we will identify stale dated checks. Ea ch 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:

 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 a nd 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 cust omer 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:

 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 recommenda tion 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 wo rksheet 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 th at is cleared daily by the supervisors. The managers and vice president review this report regularly to ensure all pa yments 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 approp riate 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 thro ughout 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:
 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:
 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 wh ereby 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:
 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 t o r e p o r t c l a i m s d i r e c t l y t o L W P . I t i s p r e - populated with each client’s contact information and organizati onal structure. Designated staff can then log in to this secure system. Once a claim is created the client w ill 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 app lication 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:
 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:
 Cumulative Loss Runs (can be provided at any organizational level)  Fiscal Period Report (including detailed financial tr ansactions, 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
 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:
 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 sta ff: 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 co mmit 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. Spread sheets 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 fina ncial controls are listed in that document and are independently audited annually.

Among the many actions we take to ensure quality and financial 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
 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
 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
 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 Claims Best Practices
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 Restrictions on who can set up accounts and require ments about documentation of approval for access and authorization
 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 allo ws 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.

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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LWP Litigation Philosophy

LWPs philosophy is to:
 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:

 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:

 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:

 Adjuster Notes
 Correspondence
 Investigation Reports
 Medical Records
 Payment details and totals
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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.

Litigation Best Practices
LWP Claims Solutions Revised March 2023 Page 4
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.  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 docu
ments 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 lo
cal jurisdiction. Where travel outside the local jurisdiction is anticipated, counsel
must obtain prior approval before billing. On the rare occasion that airfare Litigation Best Practices

LWP Claims Solutions Revised March 2023 Page 5

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.

 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.

 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:
 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.
 Respond to all phone calls and emails within 24 hours.  Send all correspondence via fax to: (408) 725-0395 or by mail Litigation Best Practices

LWP Claims Solutions Revised March 2023 Page 6

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

Deposition Scheduling:

 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.  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.  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.
 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.
 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.
 Counsel should file all Petitions on walk through calendar.  Whenever possible defense counsel will walk through any settlements without a conference.

Litigation Best Practices

LWP Claims Solutions Revised March 2023 Page 7

Applicant treating with non-MPN doctor:

 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:

 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:

 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
 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.

Litigation Best Practices

LWP Claims Solutions Revised March 2023 Page 8

Settlement:

 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.
 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 Litigation Best Practices

LWP Claims Solutions Revised March 2023 Page 9

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.
 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

Sample Reporting Package

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 1708000026 Reynaga, Jorge IND 0% .00 .00 .00
DOB: 04/10/1987 (29) DOH: 02/01/2007 3/23/2017 3/23/2017 4/6/2018 LAE 0% .00 .00 .00 Occupation: Plant Manager MED 100% 5,000.00 750.00 4,250.00 Account Level 1: Sample Client Type: Indemnity 4850 0% .00 .00 .00 Level 2: California Distribution Status: Open (04/06/2018) Total 5,000.00 750.00 4,250.00 Level 3: Plant Maintenance
Level 4: Cause: Fall, Slip, or Trip - On Site: Ankle
Policy Number: XYZ23567 Policy Period: 01/01/2017 - 12/31/2017 Nature: Strain or Tear Agency: Fall-Different Level/ Two EE's were lifting a 50 ft truss causing to feel a pull in his right arm 1708000027 Banner, Robert Bruce IND 14% 2,500.00 1.00 2,499.00 DOB: None () DOH: None 1/4/2017 1/6/2017 5/17/2018 LAE 17% 3,000.00 1.00 2,999.00 Occupation: Policeman MED 69% 12,500.00 1.00 12,499.00
Account Level 1: Sample Client Type: Indemnity 4850 0% .00 .00 .00 Level 2: Police Status: Open (05/17/2018) Total 18,000.00 3.00 17,997.00 Level 3: Police
Level 4: Cause: Cumulative, NOC Site: Lower Back Area
Policy Number: XYZ23567 Policy Period: 01/01/2017 - 12/31/2017 Nature: Strain or Tear Agency:

Litigated
EE is claiming a CT presumptive low back injury
1708000029 Charles, Luke IND 53% 12,000.00 1.00 11,999.00 DOB: None () DOH: None 5/7/2017 5/19/2017 5/17/2018 LAE 4% 1,000.00 1.00 999.00 Occupation: Fireman MED 43% 9,750.00 1.00 9,749.00
Account Level 1: Sample Client Type: Indemnity 4850 0% .00 .00 .00 Level 2: Fire Status: Open (05/17/2018) Total 22,750.00 3.00 22,747.00 Level 3: Fire
Level 4: Cause: Other, Miscellaneous NOC Site: Lungs
Policy Number: XYZ23567 Policy Period: 01/01/2017 - 12/31/2017 Nature: Infection Agency:

Exposure to pneumonia
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 6/1/2018 LWP Demo Page 8 of 14

Employer Summary: Sample Client Open Closed Total Net Reserves Net Incurred Net Paid Net Outstanding Litigated: ***** 6% Indemnity 20 1 21 IND 41% 234,694.87 64,084.81 170,610.06 Subrogation: ***** 9% Medical Only 6 0 6 LAE 10% 56,619.50 158.00 56,461.50 Future Medical: ***** 3% First Aid 4 0 4 MED 49% 280,300.00 13,258.00 267,042.00 31 1 32 4850 0% 2,000.00 .00 2,000.00
Total 573,614.37 77,500.81 496,113.56

Overall Summary: Open Closed Total Net Reserves Net Incurred Net Paid Net Outstanding Litigated: ***** 6% Indemnity 20 1 21 IND 41% 234,694.87 64,084.81 170,610.06 Subrogation: ***** 9% Medical Only 6 0 6 LAE 10% 56,619.50 158.00 56,461.50 Future Medical: ***** 3% First Aid 4 0 4 MED 49% 280,300.00 13,258.00 267,042.00 31 1 32 4850 0% 2,000.00 .00 2,000.00
Total 573,614.37 77,500.81 496,113.56
Worker's Compensation Cumulative Loss Analysis
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015

6/1/2018 LWP Demo Page 1 of 1
Level 2 Claim Number Claimant Claim Type Status Date Opened Loss Date Close Date Total Incurred Adjuster 1708000013 Jacob, John Indemnity Open 10/17/2017 10/3/2017 0.00 Judy Adlam 1708000019 Jacob, John First Aid Open 12/14/2017 10/3/2017 0.00 Judy Adlam California Distribution 1808000001 Capoli, Joe Indemnity Open 3/29/2018 2/27/2018 14,519.96 Judy Adlam California Distribution 1808000004 Day, Windy Indemnity Open 4/4/2018 3/23/2018 0.00 VONNIR Demo California Distribution 1808000007 Figuerra, Jesus Indemnity Open 4/6/2018 4/2/2018 0.00 Riley Taylor California Distribution 1708000023 Gibbs, Alexandra Indemnity Open 4/4/2018 3/27/2017 0.00 Riley Taylor California Distribution 1808000008 Raulinaitis, Bailey Indemnity Open 4/6/2018 3/29/2018 0.00 Riley Taylor California Distribution 1808000006 Raulinaitis, Bailey First Aid Open 4/4/2018 3/30/2018 0.00 Demo User California Distribution 1708000026 Reynaga, Jorge Indemnity Open 4/6/2018 3/23/2017 5,000.00 Riley Taylor California Distribution TEST TEST, TEST Indemnity Closed 9/5/2017 9/5/2015 9/25/2017 50.00 Double- Blind California Distribution 1708000024 Thinking, Wishful Medical Open 4/6/2018 2/14/2017 0.00 Demo User California Distribution 1808000003 Thinking, Wishful Indemnity Reopened 4/4/2018 3/14/2018 0.00 Demo User California Operations 1708000012 1, Test Indemnity Open 10/17/2017 10/6/2017 31,500.00 Judy Adlam California Operations 1708000020 Claimant,
Demonstration
First Aid Open 12/14/2017 9/30/2017 0.00 Judy Adlam
California Operations 1708000021 John, Sample First Aid Open 12/14/2017 10/17/2017 0.00 Test LWP Adjuster California Operations 1808000002 Pagal, Yolanda Medical Open 3/29/2018 3/27/2018 0.00 Riley Taylor California Operations 1708000011 Sample, Test2 Medical Open 10/17/2017 10/11/2017 0.00 Judy Adlam California Operations 1808000005 Sampled, John Indemnity Open 4/4/2018 1/3/2018 0.00 VONNIR Demo California Operations 1608000002 Shelton, Vicki Medical Open 1/8/2018 12/14/2016 0.00 Test LWP Adjuster California Operations 1708000016 Test1, Rob Indemnity Open 11/8/2017 10/6/2017 1,500.00 Judy Adlam California Operations 1808000009 Valencia, Elvis Indemnity Open 4/6/2018 4/6/2018 0.00 Riley Taylor California Operations SAC0000076130 Walker, Maggie Indemnity Reopened 3/20/2015 3/19/2015 186,781.41 ZZ-Demo Examiner Fire 1708000029 Charles, Luke Indemnity Open 5/17/2018 5/7/2017 22,750.00 Riley Taylor Fire 1708000028 Maximoff, Pietro Indemnity Open 5/17/2018 11/21/2016 119,850.00 Riley Taylor Parks 1608000004 Shade, Victor Indemnity Open 5/17/2018 12/6/2016 31,830.00 Riley Taylor Police 1708000027 Banner, Robert
Bruce
Indemnity Open 5/17/2018 1/4/2017 18,000.00 Riley Taylor Police 1808000010 Rogers, Steven Medical Open 5/17/2018 1/18/2018 13,790.00 Riley Taylor Police 1508000003 Romanoff, Natasha Indemnity Open 5/17/2018 8/25/2015 14,350.00 Riley Taylor Public Works 1808000011 Maximoff, Wanda Medical Open 5/17/2018 5/4/2018 15,900.00 Riley Taylor Public Works 1508000004 Parker, Peter Indemnity Open 5/17/2018 1/22/2015 70,493.00 Riley Taylor Public Works 1508000002 van Dyne, Janet Open 5/17/2018 7/15/2015 17,000.00 Riley Taylor Public Works 1708000030 Walters, Jennifer Indemnity Open 5/17/2018 10/18/2017 10,400.00 Riley Taylor Grand Totals - 32 Claims
6/1/2018 10:45:53 AM Page 1 of 2
Valued as of 05/31/2018
LWP DEMO Claim Log
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 Jacob, John First Aid 10/3/2017 0.00 Sample Client California Operations 1708000020 Claimant, Demonstration First Aid 9/30/2017 0.00 Sample Client California Operations 1708000021 John, Sample First Aid 10/17/2017 0.00 Sample Client California Distribution 1808000006 Raulinaitis, Bailey First Aid 3/30/2018 0.00 Totals for First Aid - 4 Claims
Type Of Claim: Indemnity
Sample Client Fire 1708000028 Maximoff, Pietro Indemnity 11/21/2016 119,850.00 Sample Client Fire 1708000029 Charles, Luke Indemnity 5/7/2017 22,750.00 Sample Client Police 1508000003 Romanoff, Natasha Indemnity 8/25/2015 14,350.00 Sample Client Police 1708000027 Banner, Robert Bruce Indemnity 1/4/2017 18,000.00 Sample Client 1708000013 Jacob, John Indemnity 10/3/2017 0.00 Sample Client California Distribution 1808000008 Raulinaitis, Bailey Indemnity 3/29/2018 0.00 Sample Client Public Works 1508000004 Parker, Peter Indemnity 1/22/2015 70,493.00 Sample Client Public Works 1708000030 Walters, Jennifer Indemnity 10/18/2017 10,400.00 Sample Client Parks 1608000004 Shade, Victor Indemnity 12/6/2016 31,830.00 Sample Client California Operations 1808000009 Valencia, Elvis Indemnity 4/6/2018 0.00 Sample Client California Distribution 1708000026 Reynaga, Jorge Indemnity 3/23/2017 5,000.00 Sample Client California Distribution TEST TEST, TEST Indemnity 9/5/2015 9/25/2017 50.00 Sample Client California Distribution 1808000001 Capoli, Joe Indemnity 2/27/2018 14,519.96 Sample Client California Distribution 1808000003 Thinking, Wishful Indemnity 3/14/2018 4/11/2018 0.00 Sample Client California Distribution 1708000023 Gibbs, Alexandra Indemnity 3/27/2017 0.00 Sample Client California Distribution 1808000004 Day, Windy Indemnity 3/23/2018 0.00 Sample Client California Operations 1808000005 Sampled, John Indemnity 1/3/2018 0.00 Sample Client California Operations 1708000016 Test1, Rob Indemnity 10/6/2017 1,500.00 Sample Client California Operations SAC0000076130 Walker, Maggie Indemnity 3/19/2015 3/20/2016 186,781.41 Sample Client California Operations 1708000012 1, Test Indemnity 10/6/2017 31,500.00 Sample Client California Distribution 1808000007 Figuerra, Jesus Indemnity 4/2/2018 0.00 Totals for Indemnity - 21 Claims
Type Of Claim: Medical
Sample Client California Operations 1708000011 Sample, Test2 Medical 10/11/2017 0.00 Sample Client California Operations 1608000002 Shelton, Vicki Medical 12/14/2016 0.00 Sample Client California Distribution 1708000024 Thinking, Wishful Medical 2/14/2017 0.00 Sample Client California Operations 1808000002 Pagal, Yolanda Medical 3/27/2018 0.00 Sample Client Police 1808000010 Rogers, Steven Medical 1/18/2018 13,790.00 6/1/2018 10:47:47 AM Page 1 of 3
Valued as of 05/31/2018
LWP DEMO Closed Claim Log
Level 1: Sample Client
Level 2: Public Works

Workers’ Compensation Cumulative Loss Analysis / Plan of Action Claim Received and Amounts as of 6/1/2018
Demo Program/Carrier

FINANCIALS PAID OUTSTANDING INCURRED
INDEMNITY: 32% $1.00 $22,491.50 $22,492.50
EXPENSE: 16% $1.00 $10,999.50 $11,000.50
MEDICAL: 52% $1.00 $36,999.00

$37,000.00
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
Claimant Name: Parker, Peter
Claim Type: Indemnity
Occupation:

Date of Injury: 1/22/2015
DOB:

Age: Life Expectancy:

Claim Number: 1508000004
Employment Status:

DOH:

Disposition: Accepted
Litigated: No
Future Medical:

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.

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 Indemnity Reserve Change Within Defined Period Level 1 Medical Reserve Change Within Defined Period
Level 2 4850 Reserve Change Within Defined Period
Level 3 Expense Reserve Change Within Defined Period
Level 4 Total Reserve Change During Defined Period
Level 5 State in which Accident Occurred
First Name Policy Number
Last
Name Claim Number
SS# TPA Knowledge
Loss Date Closed Date
Occupation Impairment Percentage
Type Of Claim Carrier
Accepted, Delayed or Denied Job Classification
Open, Closed, or Re‐Opened Birth Date
Cause 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
Total Paid Indemnity Carrier Claim Number
Total Paid Medical Recovery ‐
Ind/PD/Coll
Total paid 4850 Recovery ‐ Med/BI/Comp
Total Paid Expense Recovery ‐ 4850 Differential
Total Paid Net Recovery ‐ Expense
Outstanding ‐ Ind/PD/Coll Total Recovery
Outstanding ‐ Med/BI/Comp Indemnity Recoveries Within Defined Period Outstanding ‐ 4850 Differential Medical Recoveries Within Defined Period Outstanding ‐ Expense 4850 Recoveries Within Defined Period Total Outstanding Expense Recoveries Within Defined Period Incurred Net Recovery ‐ Ind/PD/Coll Total Recoveries Within Defined Period Incurred Net Recovery ‐ Med/BI/Comp Policy Effective Date Incurred Net Recovery ‐ 4850 Differential Policy Expiration Date Incurred Net Recovery ‐ Expense Last Close Date
Total Incurred Net Current Open, closed, Or Reopened Status Indemnity Paid Within Defined Period Catastrophe Code
Medical Paid Within Defined Period Value as of date for the extract 4850 Paid Within Defined Period Date and time this extract run Expense Paid Within Defined Period Carrier Code

Employer: Sample Client
Policy Year Summary: 2015 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred Net Paid Net Outstanding Reserves Payments IND 3 1 4 IND 158,754.91 64,077.81 94,677.10 27,492.50 1.00 MO 0 0 0 LAE 29,319.50 51.00 29,268.50 13,350.50 1.00
FA 0 0 0 MED 100,500.00 12,401.00 88,099.00 61,000.00 1.00 4 1 5 4850 .00 .00 .00 .00 .00
Total 288,574.41 76,529.81 212,044.60 101,843.00 3.00
test
Policy Year Summary: 2016 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred Net Paid Net Outstanding Reserves Payments IND 2 0 2 IND 32,830.00 2.00 32,828.00 32,830.00 2.00
MO 1 0 1 LAE 16,850.00 2.00 16,848.00 16,850.00 2.00
FA 0 0 0 MED 102,000.00 2.00 101,998.00 102,000.00 2.00 3 0 3 4850 .00 .00 .00 .00 .00
Total 151,680.00 6.00 151,674.00 151,680.00 6.00
test
Policy Year Summary: 2017 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred Net Paid Net Outstanding Reserves Payments IND 8 0 8 IND 33,500.00 3.00 33,497.00 17,000.00 3.00
MO 2 0 2 LAE 7,400.00 3.00 7,397.00 5,400.00 3.00
FA 3 0 3 MED 46,250.00 753.00 45,497.00 28,750.00 3.00
13 0 13 4850 2,000.00 .00 2,000.00 .00 .00
Total 89,150.00 759.00 88,391.00 51,150.00 9.00
test
Policy Year Summary: 2018 Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred Net Paid Net Outstanding Reserves Payments IND 7 0 7 IND 9,609.96 2.00 9,607.96 6,090.00 2.00
MO 3 0 3 LAE 3,050.00 102.00 2,948.00 2,050.00 2.00
FA 1 0 1 MED 31,550.00 102.00 31,448.00 21,550.00 2.00
11 0 11 4850 .00 .00 .00 .00 .00
Total 44,209.96 206.00 44,003.96 29,690.00 6.00
Fiscal Year Report
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015

6/1/2018 LWP Demo Page 1 of 3
Employer Summary: Sample Client Amounts-To-Date 4/30/2018 - 5/31/2018 Transactions Open Closed Total Net Incurred Net Paid Net Outstanding Reserves Payments IND 20 1 21 IND 234,694.87 64,084.81 170,610.06 83,412.50 8.00 MO 6 0 6 LAE 56,619.50 158.00 56,461.50 37,650.50 8.00
FA 4 0 4 MED 280,300.00 13,258.00 267,042.00 213,300.00 8.00 31 1 32 4850 2,000.00 .00 2,000.00 .00 .00
Total 573,614.37 77,500.81 496,113.56 334,363.00 24.00
Fiscal Year Report
Claims Received and Amounts as of: 5/31/2018
Loss Date is on or after 01/01/2015

6/1/2018 LWP Demo Page 2 of 3
Transaction Date Check Number Amount Pay to the Order Of Type Claim Number Claimant 5/17/2018 1022 1.00 Barton, Clinton Payment 1208000004 Barton, Clinton 5/17/2018 1023 1.00 GURVITZ & MARLOWE LLP Payment 1208000004 Barton, Clinton 5/17/2018 1024 1.00 THE PERM MED FRP INC STR Payment 1208000004 Barton, Clinton 5/17/2018 1025 1.00 GURVITZ & MARLOWE LLP Payment 1308000003 Lang, Scott 5/17/2018 1026 1.00 Lang, Scott Payment 1308000003 Lang, Scott 5/17/2018 1027 1.00 THE PERM MED FRP INC STR Payment 1308000003 Lang, Scott 5/18/2018 1028 1.00 Charles, Luke Payment 1708000029 Charles, Luke 5/18/2018 1029 1.00 Danvers, Carol Payment 1408000002 Danvers, Carol 5/18/2018 1030 1.00 GURVITZ & MARLOWE LLP Payment 1808000011 Maximoff, Wanda 5/18/2018 1031 1.00 GURVITZ & MARLOWE LLP Payment 1808000010 Rogers, Steven 5/18/2018 1032 1.00 GURVITZ & MARLOWE LLP Payment 1708000030 Walters, Jennifer 5/18/2018 1033 1.00 GURVITZ & MARLOWE LLP Payment 1708000029 Charles, Luke 5/18/2018 1034 1.00 GURVITZ & MARLOWE LLP Payment 1708000027 Banner, Robert Bruce 5/18/2018 1035 1.00 GURVITZ & MARLOWE LLP Payment 1708000028 Maximoff, Pietro 5/18/2018 1036 1.00 GURVITZ & MARLOWE LLP Payment 1608000004 Shade, Victor 5/18/2018 1037 1.00 GURVITZ & MARLOWE LLP Payment 1508000004 Parker, Peter 5/18/2018 1038 1.00 GURVITZ & MARLOWE LLP Payment 1408000002 Danvers, Carol 5/18/2018 1039 1.00 GURVITZ & MARLOWE LLP Payment 1408000001 Stark, Anthony 5/18/2018 1040 1.00 GURVITZ & MARLOWE LLP Payment 1308000002 Odinson, Thor 5/18/2018 1041 1.00 Maximoff, Pietro Payment 1708000028 Maximoff, Pietro 5/18/2018 1042 1.00 Maximoff, Wanda Payment 1808000011 Maximoff, Wanda 5/18/2018 1043 1.00 Odinson, Thor Payment 1308000002 Odinson, Thor 5/18/2018 1044 1.00 Parker, Peter Payment 1508000004 Parker, Peter 5/18/2018 1045 1.00 Rogers, Steven Payment 1808000010 Rogers, Steven 5/18/2018 1046 1.00 Shade, Victor Payment 1608000004 Shade, Victor 5/18/2018 1047 1.00 ST MARYS US HEALTHWORKS Payment 1708000030 Walters, Jennifer 5/18/2018 1048 1.00 Stark, Anthony Payment 1408000001 Stark, Anthony 5/18/2018 1049 1.00 THE PERM MED FRP INC STR Payment 1308000002 Odinson, Thor 5/18/2018 1050 1.00 US HEALTH & ORTHOPEDIC Payment 1708000028 Maximoff, Pietro 5/18/2018 1051 1.00 US HEALTH & ORTHOPEDIC Payment 1508000004 Parker, Peter 5/18/2018 1052 1.00 US HEALTH & ORTHOPEDIC Payment 1408000002 Danvers, Carol 5/18/2018 1053 1.00 US HEALTH & ORTHOPEDIC Payment 1408000001 Stark, Anthony 5/18/2018 1054 1.00 US Health and Orthopedic Medic Payment 1808000010 Rogers, Steven 5/18/2018 1055 1.00 US Health and Orthopedic Medic Payment 1708000029 Charles, Luke 5/18/2018 1056 1.00 US Health and Orthopedic Medic Payment 1608000004 Shade, Victor 5/18/2018 1057 1.00 US HEALTHWORKS Payment 1708000027 Banner, Robert Bruce 5/18/2018 1058 1.00 US HEALTHWORKS MED GRP Payment 1808000011 Maximoff, Wanda 6/5/2018 2:03:22 PM Page 1 of 3
Check RegisterLWP DEMO
LWP Claims Solutions
Reconciliation Report
Prepared by: Stephanie Kinyon Reviewed by: Helen Costa
Date Competed: 1/10/2023 Date Reviewed: 1/18/2023
Bank Balance Register Balance
Previous Balance (Per Statement) 4,792.24 Bank Balance 31,245.00 Checks and Payments - Cleared (249.23) Checks and Payments (Outstanding) (567.46) Deposits and Credits - Cleared 26,701.99 Other Outstanding Items - Reconciled Items/Data Corrections, Sto -
Service Charge -
Interest Earned - Register Balance (Calculated) 30,677.54 Ending Balance (Calculated) 31,245.00 Register Balance (Per Origami Register) 30,677.54 Ending Balance (Per Statement) 31,245.00 Variance - Outstanding Items
Date Transaction ID Amount Description
Total Outstanding Items -
Outstanding Checks
Date Check Number Amount Payee Type Claim Claimant Name 12/21/2022 6631 498.46 Hand Therapy Doctors Issued 2212300096 Injured, Worker 12/27/2022 6632 69.00 Pharmacy Issued 2212300096 Injured, Worker Total Outstanding Checks 567.46
Bank 123
December-22
Sample Reconciliation

Page 1 of 1 ends

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

As of September, 2022 Page | 2

Sample - Schools Claim Summary
Policy Year Closed Open Re-Open Grand
Total
Total
Incurred
# of Claims >
$125k Incurred
Paid over
$125k
Incurred
(Exc. Excess)
07/01/2007-06/30/2008 285 3 1 289 $5,075,791 4 $2,428,865 $1,378,500 07/01/2008-06/30/2009 266 2 268 $3,214,056 7 $1,287,362 $1,926,693 07/01/2009-06/30/2010 253 1 1 255 $1,977,183 0 $0 $1,977,183 07/01/2010-06/30/2011 230 5 1 236 $4,200,118 7 $1,713,512 $2,069,951 07/01/2011-06/30/2012 225 1 226 $2,602,942 5 $1,401,112 $1,201,831 07/01/2012-06/30/2013 211 6 217 $2,575,033 3 $478,061 $1,849,508 07/01/2013-06/30/2014 215 5 1 221 $2,117,165 4 $377,041 $1,448,655 07/01/2014-06/30/2015 222 4 2 ` $2,774,687 7 $812,125 $1,576,057 07/01/2015-06/30/2016 225 6 2 233 $3,145,634 5 $907,023 $1,923,183 07/01/2016-06/30/2017 217 5 222 $2,672,291 3 $591,682 $1,664,098 07/01/2017-06/30/2018 211 9 3 223 $3,022,536 5 $1,014,001 $1,727,275 07/01/2018-06/30/2019 235 13 2 250 $3,001,637 7 $587,654 $1,592,276 07/01/2019-06/30/2020 150 20 1 171 $2,794,777 3 $483,623 $1,729,377 07/01/2020-06/30/2021 65 15 80 $1,668,804 6 $193,051 $604,507 07/01/2021-06/30/2022 142 43 185 $1,651,031 2 $0 $1,366,282 07/01/2022-06/30/2023 2 22 24 $148,011 0 $0 $148,011
Grand Total 315
4 157 17 3100 $42,641,695 68 $12,275,111 $24,183,387
Valued as of 9/30/22
2007-
2008
2008-
2009
2009-
2010
2010-
2011
2011-
2012
2012-
2013
2013-
2014
2014-
2015
2015-
2016
2016-
2017
2017-
2018
2018-
2019
2019-
2020
2020-
2021
2021-
2022
2022-
2023
Open 4226166685 1 2 1 5 2 1 1 5 4 3 2 2
Closed 285 266 253 230 225 211 215 222 225 217 211 235 150 65 142 2 0 50
100
150
200
250
300
350
Claim Status as of 9/30/2022
Closed Open

As of September, 2022 Page | 3

Summary of Claim Status as of
Total Open as of 6/30/13 6/30/15 6/30/17 6/30/19 6/30/20 6/30/21 6/30/22 9/30/22 First Aid 4 1 1 - - Indemnity 208 2 08 186 199 1 69 138 157 1 55 Indemnity 123 1 59 119 140 1 05 7 9 92 9 1 Future Medical 85 4 9 6 7 59 6 4 5 9 65 6 4 Medical Only 44 3 5 2 1 32 1 3 6 23 1 9 Grand Total 256 2 43 208 232 1 82 144 180 1 74 Total Outstanding as of 6/30/13 6/30/15 6/30/17 6/30/19 6/30/20 6/30/21 6/30/22 9/30/22 First Aid $2,883 $0 $1,690 $230 $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 Indemnity $3,660,941 $5,483,740 $3,160,378 $3,552,145 $3,779,900 $3,361,412 $3,348,313 $3,450,220 Future Medical $6,358,370 $3,393,645 $3,650,078 $3,856,597 $4,119,443 $3,419,909 $3,738,640 $3,588,975 Medical Only $26,986 $81,952 $54,406 $59,104 $36,784 $17,624 $110,542 $93,312 Grand Total $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 6/30/13 6/30/15 6/30/17 6/30/19 6/30/20 6/30/21 6/30/22 9/30/22 First Aid $3,162 $6,057 $17,171 $17,429 $17,701 $17,701 $18,672 $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 Indemnity $7,729,125 $13,204,855 $14,059,231 $18,231,993 $19,327,520 $19,797,760 $21,279,344 $21,794,425 Future Medical $11,738,106 $10,549,235 $13,368,822 $15,043,925 $17,210,951 $18,089,086 $19,616,217 $19,549,576 Medical Only $388,281 $611,749 $760,394 $964,300 $1,065,562 $1,093,038 $1,271,839 $1,278,269 Grand Total $19,858,674 $24,371,896 $28,205,618 $34,257,647 $37,621,734 $38,997,585 $42,186,072 $42,641,695256 243 208
232
182
144
180 174
0 50
100
150
200
250
300
June 2013 June 2015 June 2017 June 2019 June 2020 June 2021 June 2022 Sep-22 Claims Open as of

As of September, 2022 Page | 4

Paid by Category
Paid in Period 7/1/2018 -
6/30/2019
7/1/2019 -
6/30/2020
7/1/2020 -
6/30/2021
7/1/2021 -
6/30/2022
7/1/2022 -
6/30/2023
Payment Category
Exp $406,151 $383,002 $202,965 $239,241 $73,015
Med $1,507,704 $1,279,544 $1,134,343 $1,366,340 $265,923 Rehab $4,420 $9,142 $12,898 $2,600
Ind $927,661 $1,151,697 $1,308,917 $1,184,309 $182,426
Salary Continuation
Temporary Disability $632,788 $586,753 $567,159 $936,462 $127,609 Permanent Disability $171,326 $415,822 $431,306 $239,736 $54,818 Settlement $123,547 $149,121 $310,453 $8,110 $0
Grand Total $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
Open
FM
Open Total
Incurred
TEAMSTERS--M & O 218 $4,314,699 182 $1,150,401 25 11 $3,164,297 MDEA 171 $1,768,712 139 $279,728 29 3 $1,488,984
CSEA 167 $1,613,217 141 $463,874 23 3 $1,149,343
TEAMSTERS--Transp 35 $729,420 28 $110,126 7 0 $619,294
CST 28 $259,345 24 $61,484 3 1 $197,861
DMA 23 $227,075 21 $90,640 2 0 $136,435
MDSPA 7 $100,616 6 $13,383 0 1 $87,234
SUBSTITUTE 28 $117,772 24 $31,417 4 0 $86,355
CLASSIFIED UNREPRESENTED 10 $65,316 8 $6,764 2 0 $58,552 TEAMSTERS --TIS 8 $29,042 7 $10,072 1 0 $18,970
TEAMSTERS--FS (food services) 10 $27,301 9 $13,944 1 0 $13,357 SUPERVISORY 4 $2,403 4 $2,403 0 0 $0
VOLUNTEER 1 $9,343 1 $9,343 0 0 $0
Grand Total 710 $9,264,259 594 $2,243,578 97 19 $7,020,681

As of September, 2022 Page | 5

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

As of September, 2022 Page | 6

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

As of September, 2022 Page | 7

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

As of September, 2022 Page | 8

Followed by other grouping by levels specified by Client

Administration
Locations Within Department
7/1/18 - 9/30/22
# of Closed
Claims
Total Incurred
Closed Claims
# of Open
Claims
Total Incurred
Open Claims
Total # of
Claims
Total Incurred
Central Kitchen 1 298.87 0.00 1 298.87 Dent Center 2 5,771.40 0.00 2 5,771.40 Director of Personnel 1 259.49 0.00 1 259.49 Director Student Services 2 490.81 0.00 2 490.81 Director Tech & Info Services 1 6,976.74 0.00 1 6,976.74 District-Wide 87,233.52 1 87,233.52 Exec Dir Instruct Support 1 1,291.39 0.00 1 1,291.39 Fiscal Services 1 985.97 0.00 1 985.97 Purchasing Department 1 29,958.90 0.00 1 29,958.90 Special Education Director 1 760.20 1 0.00 1 760.20 Substitute Service 1 105.95 0.00 1 105.95 Administration 12 46,899.72 1 87,233.52 13 134,133.24
Alternative Education
Locations Within Department
7/1/18 - 9/30/22
# of Closed
Claims
Total Incurred
Closed Claims
# of Open
Claims
Total Incurred
Open Claims
Total # of
Claims
Total Incurred
Facility 1 2 1,089.18 0 0.00 2 1,089.18
Facility 2 1 1,980.00 1 1,980.00
Facility 3 1 6,694.10 0 0.00 1 6,694.10
Facility 4 12 61,130.68 3 82,562.40 15 143,693.08
Facility 5 3 6,216.69 0 0.00 3 6,216.69
Facility 6 7 18,928.14 1 3,112.00 8 22,040.14
Facility 7 5 64,243.09 0 0.00 5 64,243.09
Facility 8 1 603.50 0 0.00 1 603.50
Facility 9 2 3,220.93 1 56,921.75 3 60,142.68
Facility 10 2 1,079.03 0 0.00 2 1,079.03
Facility 11 2 733.92 0 0.00 2 733.92
Facility 12 1 7,489.82 1 7,489.82
Facility 13 1 15,038.33 1 15,038.33
Facility 14 1 5,089.32 0 0.00 1 5,089.32
Alternative Education 38 169,028.58 8 167,104.30 46 336,132.88

As of June 30, 2022 Page | 1

Sample Quarterly Stewardship
Pool
As of
June 30, 2022

As of June 30, 2022 Page | 2
July 1, 2013 ‐ Present
10,305,286
7,378,790
0 2,500,000
5,000,000
7,500,000
10,000,000
12,500,000
July 2013 Jun-22
Total Outstanding - All Claims
400
305
0 100
200
300
400
500
July 2013 Jun-22
Total Count of Open Claims

As of June 30, 2022 Page | 3

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

22 As of June 30, 20 Page | 4
Summyar of Claim Status as of
Total Opena s of //13063 /4/6013 //05631 //01663 /76/301 /0/1863 /96/301 /0/2063 /16/023 /23/312 AitFisdr 3 1 1 1 2 3 1 eiIndnymt 406 682 962 762 072 842 032 212 652 932 Indenimyt 163 64 13 33 43 29 15 06 701 89 elediauFurt Mc 243 042 832 432 632 651 971 251 941 141 lynl OaicdeM - 95 46 54 16 14 35 57 06 38 lato TdnaGr 604 843 433 313 233 982 582 092 713 223 Total Outstanding as of //13063 /4/6013 //05631 //01663 /76/301 /0/1863 /96/301 /0/2063 /16/023 /23/312 AitFisdr $250 $215 $120 $1,315 $3,579 $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 $9,271,073 $7,846,665 Indenimyt $1,857,474 $878,656 $665,027 $550,706 $653,619 $913,022 $2,283,857 $2,324,576 $5,586,159 $4,499,517 elediauFurt Mc $9,223,479 $7,550,982 $6,071,569 $5,402,800 $5,248,242 $4,671,289 $4,216,963 $3,651,865 $3,684,914 $3,347,147 lynl OaicdeM $83,917 $237,942 $107,226 $149,888 $148,480 $317,041 $440,860 $378,318 $559,098 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 //13063 /4/6013 //05631 //01663 /76/301 /0/1863 /96/301 /0/2063 /16/023 /23/312 AitFisdr $10,066 $12,696 $13,507 $13,627 $13,809 $15,124 $17,659 $15,094 $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 Indenimyt $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 elediauFurt Mc $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 lynl OaicdeM $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 Grand Total $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 As of June 30, 2022 Page | 5

Member Claim Summary with all Members with Claims After 7/1/2016 # of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred # of Claims Incurred Member 1 1 $1,311 1 $4 2 $1,315
Member 2 73 $428,717 74 $317,037 93 $1,156,491 65 $1,546,622 75 $2,117,109 60 $426,775 440 $5,992,751 Member 3 78 $627,341 55 $259,146 65 $725,081 54 $548,110 66 $653,192 66 $720,494 384 $3,533,364 Member 4 8 $240,937 6 $2,752 12 $56,600 7 $32,654 10 $96,818 11 $4,754 54 $434,514 Member 5 52 $237,125 57 $375,505 68 $506,009 88 $507,659 78 $970,621 43 $137,093 386 $2,734,013 Member 6 1 $4,917 1 $4,917
Member 7 175 $1,237,559 171 $393,116 148 $1,922,618 143 $1,414,982 113 $714,852 82 $362,438 832 $6,045,565 Member 8 1 $112 1 $112
Member 9 1 $177 1 $177
Member 10 2 $204 1 $102 3 $305
Member 11 9 $67,166 7 $1,879 4 $26,591 1 $476 5 $169,221 2 $7,484 28 $272,817 Member 12 2 $4,367 2 $4,367
Member 13 2 $127,048 1 $109,779 4 $150,240 7 $387,067
Member 14 1 $151 1 $151
Member 15 3 $14,748 4 $100 2 $326 4 $140 2 $1,550 4 $23,946 19 $40,811 Member 16 1 $13 1 $193 1 $309 3 $514
Grand Total 404 $2,986,332 378 $1,459,670 399 $4,544,427 364 $4,055,672 350 $4,723,672 269 $1,682,988 2164 $19,452,761 Total # of Claims Total Incurred2016-2017 2017-2018 2018-2019 2019-2020 2020-2021 2021-2022 Paid in Year by Payment Category
Paid in Period 2016 ‐17 2017 ‐18 2018 ‐19 2019 ‐20 2020 ‐21 2021 ‐22 Grand Total Indemnity $905,381 $1,299,215 $1,706,916 $1,285,587 $1,165,132 $2,086,210 $8,448,441 Temporary Disability $207,144 $233,827 $193,912 $164,953 $430,429 $409,313 $1,639,577 Permanent Disability $471,483 $738,860 $747,774 $649,260 $523,801 $655,157 $3,786,336 Settlement $219,701 $311,223 $751,883 $450,337 $190,256 $1,005,845 $2,929,246 Other Indemnity $7,053 $15,305 $13,347 $21,036 $20,645 $15,896 $93,282 4850 $704,403 $542,567 $555,006 $911,689 $1,673,943 $1,288,144 $5,675,751 Medical $
1,115,778 $1,261,354 $987,469 $1,090,424 $2,134,800 $1,120,657 $7,710,483 Medical $
812,544 $849,925 $822,099 $875,097 $1,571,527 $945,967 $5,877,159 Nurse Case Management $507 $0 $0 $1,857 $49,456 $28,331 $80,150 Hospital & Surgery $302,728 $411,428 $165,371 $213,471 $513,818 $146,359 $1,753,174 Expense $261,727 $241,282 $267,130 $268,352 $230,650 $241,416 $1,510,559 Other Expense $211,681 $194,847 $213,485 $218,249 $164,626 $204,632 $1,207,520 Utilization Review $11,158 $8,496 $13,530 $6,816 $8,536 $4,042 $52,577 Bill Review $38,888 $37,939 $40,116 $43,288 $57,489 $32,742 $250,462 Grand Total $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 | 6

Covid Summary
Indemnity Medical First Aid Indemnity Medical First Aid 2020
Qtr1 2 4 6 $5,187.98
Qtr2 2 4 6 $62,819.01 1
Qtr3 1 29 30 $8,870.32
Qtr4 2 23 6 31 $32,235.97 1
2021
Qtr1 1 5 2 8 $1,626.21
Qtr2 3 3 $4.00
Qtr3 1 7 8 $13,296.55
Qtr4 1 4 5 10 $2,817.31
2022
Qtr1 2 39 41 $294.00 2
Total 10 81 52 143 $127,151.35 1 3 0
Reported Claim T
ype Total Claims Total Incurred Open as of 3/31/2022

As of June 30, 2022 Page | 7

Member C - Recent Claim Summary
Contract Year Grand Total Total
Total Incurred Indemnity MO First Aid Open
07/01/2016-06/30/2017 52 52 $237,125 0
07/01/2017-06/30/2018 53 2 2 57 $375,505 3 1 4
07/01/2018-06/30/2019 64 3 1 68 $506,009 3 1 4
07/01/2019-06/30/2020 78 7 3 88 $507,659 7 3 10
07/01/2020-06/30/2021 69 8 1 78 $970,621 9 9
07/01/2021-06/30/2022 33 10 43 $137,093 4 6 10
Grand Total 349 30 7 386 $2,734,013 26 11 0 37
Valued as of 6/30/2022
Closed Open Re-Open Open by Claim Type
Paid in Year by Payment Category
Paid in Period 2016 ‐17 2017 ‐18 2018 ‐19 2019 ‐20 2020 ‐21 2021 ‐22 Grand Total Indemnity $93,883 $69,449 $144,471 $133,261 $146,276 $150,336 $737,676 Temporary Disability $12,687 $6,825 $2,194 $34,050 $28,488 $84,233 $168,478 Permanent Disability $44,097 $40,244 $94,253 $54,867 $98,088 $55,260 $386,808 Settlement $31,099 $16,380 $40,822 $32,255 $17,555 $10,748 $148,859 Other Indemnity $6,000 $6,000 $7,202 $12,090 $2,145 $95 $33,532 4850 $28,813 $41,701 $191,102 $241,336 $176,276 $256,481 $935,708 Medical $109,696 $122,847 $125,742 $153,142 $125,001 $152,211 $788,639 Medical $96,289 $104,574 $93,987 $108,399 $96,546 $140,679 $640,473 Nurse Case Management $0 $0 $0 $633 $0 $1,081 $1,714
Hospital & Surgery $13,407 $18,273 $31,755 $44,111 $28,455 $10,451 $146,453 Expense $28,496 $18,373 $25,254 $16,894 $20,708 $22,767 $132,491 Other Expense $23,255 $13,133 $18,946 $9,464 $13,506 $18,757 $97,060 Utilization Review $280 $670 $1,693 $280 $0 $0 $2,923
Bill Review $4,961 $4,570 $4,615 $7,150 $7,202 $4,010 $32,508 Grand Total $260,887 $252,370 $486,568 $544,633 $468,260 $581,795 $2,594,514

As of June 30, 2022 Page | 8

Member C Claim Summary ‐ Continued

Followed by Summary for each Pool Member

Covid Summary
Indemnity Medical First Aid
2020
Qtr1 2 2 $0.00
Qtr2 1 1 $396.99
Qtr3 1 17 18 $7,503.43
Qtr4 9 5 14 $2,889.18
2021
Qtr1 1 1 $1,313.77
Qtr2 0 $0.00
Qtr3 1 2 3 $13,284.55
Qtr4 0 $0.00
2022
Qtr1 3 3 $0.00
Total 3 31 8 42 $25,387.92
Reported Claim T
ype Total Claims Total Incurred
Top 5 Departments for PY 2019/20 ‐ 2021/22
# of Claims Total Outstanding Total Incurred
Police 103 $393,724.51 $1,049,086.35
Fire 61 $152,758.28 $436,785.76
Recreation 20 $7,966.07 $62,044.75
Community Development 3 $15,704.74 $56,863.84
Public Works 14 $1,050.00 $5,386.40
Largest Departments by Total Incurred 201 $571,203.60 $1,610,167.10

As of June 30, 2022 Page | 9

Open Claims by Member
Indemnity MO Future Medical Total # Total Outstanding Total Incurred Member 1 26 23 37 86 $2,299,690.93 $8,405,045.00
Member 2 28 23 27 78 $1,635,378.24 $4,112,615.00
Member 3 1 2 3 6 $103,848.19 $505,580.00
Member 4 14 10 29 53 $995,398.09 $3,260,189.00
Member 5 24 23 41 88 $2,919,255.79 $11,689,259.00
Member 6 1 1 $36,298.65 $90,579.00
Member 7 3 2 5 $307,184.46 $835,949.00
Member 8 1 1 1 3 $97,833.24 $201,062.00
Member 9 1 1 9 11 $10,874.83 $23,792.00
Grand Total 98 83 150 331 $8,405,762.42 $29,124,070.00
10 Largest Open Claims by Outstanding
Policy Period Employer Name Level 1C l a i m Number Future Medical Total Paid Net Total Outstanding Total Incurred Net 07/01/2020 - 06/30/2021 Member A Public Works 1 False $101,281 $342,812 $444,093 07/01/2021 - 06/30/2022 Member B Fire 2 False $4,436 $287,151 $291,586 07/01/2019 - 06/30/2020 Member C Sheriff-Civil 3 False $220,425 $222,813 $443,238 07/01/2009 - 06/30/2010 Member D Sheriff-Patrol 4 True $359,106 $203,761 $562,867 07/01/2015 - 06/30/2016 Member E Sheriff-Patrol 5 True $211,145 $200,644 $411,789 07/01/2008 - 06/30/2009 Member F Police 6 True $284,462 $175,540 $460,002 07/01/2006 - 06/30/2007 Member G Elementary School 7 True $283,910 $167,875 $451,785 07/01/2019 - 06/30/2020 Member H General Services De
partm 8 False $225,937 $157,434 $383,371
07/01/2018 - 06/30/2019 Member I District Attorney 9 False $67,368 $143,913 $211,281 07/01/2019 - 06/30/2020 Member j Police 10 False $165,033 $138,383 $303,416 $1,923,102 $2,040,326 $3,963,429
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
10/31/22 Open-New Re-
Open
Conversions Closed Total Open Inventory
11/30/22
Indemnity 68 1 0 0 5 64
Future Medical 42 0 0 0 0 42
Medical 29 6 0 0 9 26
First Aid 0 1 0 0 1 0
Grand Total 139 8 0 0 15 132
New Claims November 22:

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

Claim
Number Claimant Loss Date Occupation
Employee
Class
Total
Incurred Close Date
Type Of
Claim
2293800117 Claimant 1 11/14/2022 Special Ed Teacher Classified $0.00 11/15/2022 First Aid 2293800112 Claimant 2 10/27/2022 Custodian Classified $157.50 11/23/2022 Medical 2293800106 09/29/2022 Site Computer Tech Classified $738.06 11/14/2022 Indemnity 2293800103 09/28/2022 Academic Specialist Classified $440.70 11/21/2022 Indemnity 2293800099 09/21/2022 Special Ed. Teacher Classified $166.04 11/21/2022 Medical 2293800095 09/16/2022 Para Professional 1 Classified $593.87 11/29/2022 Medical 2293800093 09/14/2022 Speech Language Pathologist Classified $221.52 11/14/2022 Medical 2293800092 09/12/2022 Teacher Certificated $221.52 11/03/2022 Medical 2293800091 09/13/2022 Kindergarten Teacher Certificated $11.55 11/29/2022 Medical 2293800085 09/02/2022 Custodian Classified $178.87 11/07/2022 Medical 2293800080 08/31/2022 Paraprofessional 3 Classified $647.17 11/10/2022 Indemnity 2293800076 08/29/2022 Plant Supervisor Classified $772.96 11/28/2022 Medical 2293800045
3 4
5 6
7 8
9 10
11 12
13 04/06/2022 Speech Therapist Classified $2,486.73 11/14/2022 Medical 2193800037 08/27/2021 Child Nutritionist Assistant 1 Classified $26,829.02 11/28/2022 Indemnity 1493800026
Claimant 1
Claimant 2 08/12/2014 custodian Classified $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 Total Outstand. Reserve 11/30/22 Net Monthly Change $6,569,119 $6,732,099 $162,980
Total Incurred 10/31/22 Total Incurred 11/30/22
$52,013,350 $52,296,253 $282,903
Total Paid 10/31/22 Total Paid 11/30/22
$45,354,231 $45,564,154 $209,923
** 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.

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

Local Municipality As of 6-30-22
Claims Per Fiscal Year 7-1-13 to 6-30-22
Policy Year Claim Count Total Paid Total Outstanding Total Incurred Litgated Count in Last 5 Years % Average of Net Total Paid Average of Net Total Incurred 7/1/2005 10 $2,881.73 $0.00 $2,881.73 True 3 7.50% $26,848.07 $33,573.66 7/1/2006 17 $193,929.00 $0.00 $193,929.00 Non litigated 37 $1,763.04 $1,913.67 7/1/2007 13 $46,125.46 $0.00 $46,125.46 Total 40
7/1/2008 9 $73,522.07 $0.00 $73,522.07
7/1/2009 5 $28,376.94 $0.00 $28,376.94
7/1/2010 6 $1,395.79 $0.00 $1,395.79
7/1/2011 8 $447,808.37 $255,181.06 $702,989.43
7/1/2012 4 $57,210.87 $0.00 $57,210.87 7-1-13 to 6-30-22 7/1/2013 4 $197,029.64 $0.00 $197,029.64 Department Claim Count Total Paid Total Outstanding Total Incurred 7/1/2014 8 $3,307.00 $0.00 $3,307.00 8 $3,079.23 $1,320.00 $4,399.23 7/1/2015 7 $238,904.85 $0.00 $238,904.85 Cafeteria 3 $1,367.05 $0.00 $1,367.05 7/1/2016 9 $70,572.94 $0.00 $70,572.94 District Office 3 $51,069.73 $0.00 $51,069.73 7/1/2017 4 $1,407.83 $0.00 $1,407.83 Elementary School 13 $31,391.71 $20,176.77 $51,568.48 7/1/2018 2 $1,506.78 $0.00 $1,506.78 High School 8 $57,170.82 $4,253.25 $61,424.07 7/1/2019 9 $2,316.06 $0.00 $2,316.06 Madison High School 1 $95.48 $0.00 $95.48 7/1/2020 13 $75,610.41 $24,430.02 $100,040.43 Maintenance 3 $1,380.00 $0.00 $1,380.00 7/1/2021 9 $65,014.02 $0.00 $65,014.02 Transportation 1 $222.82 $0.00 $222.82 7/1/2022 7 $1,329.57 $1,320.00 $2,649.57
Grand Total 40 $145,776.84 $25,750.02 $171,526.86
Type of Claim Count Policy Year Claim Count Average Cost All Open 7/1/2018 2 7/1/2000 10 $288.17 Policy Year Claim Count Total Paid Total Outstanding Total Incurred Indemnity 2 7/1/2001 17 $11,407.59 Future Medical 3 $342,128.27 $259,434.31 $601,562.58 7/1/2019 9 7/1/2002 13 $3,548.11 7/1/2008 2 $319,470.91 $255,181.06 $574,651.97 First Aid 3 7/1/2003 9 $8,169.12 7/1/2019 1 $22,657.36 $4,253.25 $26,910.61 Indemnity 1 7/1/2004 5 $5,675.39 Indemnity 1 $28,623.22 $20,176.77 $48,799.99 Medical Only 5 7/1/2005 6 $232.63 7/1/2019 1 $28,623.22 $20,176.77 $48,799.99 7/1/2020 13 7/1/2006 8 $55,976.05 Medical Only 1 $0.00 $1,320.00 $1,320.00 First Aid 1 7/1/2007 4 $14,302.72 7/1/2022 1 $0.00 $1,320.00 $1,320.00 Indemnity 4 7/1/2008 4 $49,257.41 Total 5 $370,751.49 $280,931.08 $651,682.57 Medical Only 8 7/1/2009 8 $413.38
7/1/2021 9 7/1/2010 7 $34,129.26
First Aid 2 7/1/2011 9 $7,841.44
Indemnity 2 7/1/2012 4 $351.96
Medical Only 5 7/1/2013 2 $753.39
7/1/2022 7 7/1/2014 9 $257.34
First Aid 1 7/1/2015 13 $5,816.19
Medical Only 6 7/1/2016 9 $7,223.78
7/1/2017 7 $189.94
Average 8 $11,435.21

LWP Claims Solutions, Inc

Pool Client Sample Reserve Change Summary
04/2020 – 03/2021

-
500,000.00
1,000,000.00
1,500,000.00
2,000,000.00
Reserve Change by Period
250
260
270
280
290
300
310
320
330
Total Open Claims as of

LWP Claims Solutions, Inc

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

LWP Claims Solutions, Inc

Claims with Reserve Change over $50k from 4/2020 – 3/2021

Claim Number Loss Date Status Employer
Name Reserve Change in Period
100 4/28/2016 O Member 5 672,731.68
101 1/21/2020 O Member 5 418,237.78
102 9/12/2020 O Member 5 254,169.39
103 11/21/2016 O Member 3 252,133.51
104 8/16/2015 O Member 5 239,906.20
105 2/12/2019 O Member 5 226,036.25
106 6/3/2020 O Member 5 218,167.95
107 6/14/2019 O Member 2 200,934.20
108 9/18/2020 O Member 1 177,601.51
109 4/7/2019 O Member 5 172,213.28
110 6/30/2017 O Member 2 166,595.06
111 9/18/2016 O Member 5 165,863.16
112 5/31/2020 O Member 1 163,060.84
113 6/17/2020 O Member 1 151,876.21
114 8/16/2018 O Member 5 146,840.64
115 8/16/2020 O Member 1 136,547.89
116 12/13/1994 O Member 1 132,000.73
117 8/20/2019 O Member 1 129,734.48
118 9/19/2020 O Member 4 125,855.09
119 4/3/2014 O Member 5 113,411.24
120 4/21/2020 O Member 1 98,752.69
121 2/12/2020 O Member 5 98,741.89
122 8/3/2016 O Member 5 96,704.77
123 1/9/2020 O Member 5 87,382.50
124 5/9/2019 O Member 1 86,496.84
125 8/23/2020 O Member 2 82,960.43
126 9/13/2020 O Member 1 75,466.08
127 6/5/2019 O Member 5 73,832.40
128 11/19/2003 O Member 2 73,005.78
129 11/8/2020 O Member 2 71,755.45
130 10/9/2014 O Member 5 71,244.99
131 8/1/2019 O Member 2 66,534.57
132 7/7/2020 O Member 2 65,159.75
133 5/8/2020 O Member 2 63,248.13
134 2/24/2020 O Member 1 59,941.39
135 5/23/2019 O Member 1 58,264.38
136 6/4/2020 O Member 2 57,164.11
137 8/5/2020 O Member 4 55,923.24
138 6/1/2006 O Member 5 54,852.53
139 5/6/2020 O Member 4 53,875.96
140 4/2/2020 R Member 1 53,590.70
141 3/3/2014 C Member 5 -173,168.00

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 CA Municipality POLICE 1296100075 Ellliott, Sam 6/5/2012 I A Open 198,382.53 Adjuster 1 CA Municipality Fire 1796100038 Sunshine, Walker Both 5/27/2017 I A Open 8,290.40 Adjuster 1 CA Municipality Fire 1796100039 Inn, Dropp 5/27/2017 I A Open 7,281.41 Adjuster 1 CA Municipality ENVIRONMENTAL UTILITIES 1996100048 Nut, Dough 6/6/2019 I A Open 98,350.86 Adjuster 1 CA Municipality POLICE 1796100018 Bay, Green 4/2/2017 I A Open 143,042.64 Adjuster 1 CA Municipality POLICE 1996100066 Richard, Luis 8/7/2019 I A Open 35,445.00 Adjuster 1 CA Municipality ENVIRONMENTAL UTILITIES 1996100071 Jose, SaraAnn 8/15/2019 I A Open 74,129.02 Adjuster 1 CA Municipality FINANCE 8596100080 Ashli, Jacinda 12/30/1985 I A Open 98,500.79 Adjuster 1 CA Municipality POLICE 1196100087 Anthony, Dinah 7/11/2011 I A Open 261,386.11 Adjuster 1 CA Municipality POLICE 2096100015 Jessica, Adela 2/9/2020 I A Open 9,300.00 Adjuster 1 CA Municipality POLICE 1596100110 Dolores, Richard 11/3/2015 I A Open 40,257.07 Adjuster 1 CA Municipality POLICE 1196100009 Jacinda, Hugo 1/27/2011 I A Open 191,718.88 Adjuster 1 CA Municipality Human Resources 0096100076 Anita, Tate 8/1/2000 I A Open 323,903.93 Adjuster 1 CA Municipality POLICE 1596100026 Hugo, Cory 3/18/2015 I A Open 55,098.65 Adjuster 1 CA Municipality Fire 1896100112 Mayra, Amanda 10/31/2018 I A Open 45,645.00 Adjuster 1 CA Municipality Fire 1896100126 Adela, Juan 12/1/2018 I A Open 99,554.00 Adjuster 1 CA Municipality POLICE 9796100099 Paula, Jesse 9/24/1997 I A Open 41,666.97 Adjuster 1 CA Municipality POLICE 0996100059 Grace, Susan 7/1/2009 I A Open 135,457.22 Adjuster 1 CA Municipality ENVIRONMENTAL UTILITIES 1496100049 Debra, Bertha 5/23/2014 I A Reopened 9,484.74 Adjuster 1 CA Municipality LIBRARY 0596100104 Angelique, Arlita 10/13/2005 I A Open 52,849.79 Adjuster 1 CA Municipality POLICE 1596100042 Veronica, Rebecca 5/24/2015 I A Open 215,083.09 Adjuster 1 CA Municipality POLICE 0096100006 Janet, Maria 1/26/2000 I A Open 66,756.55 Adjuster 1 CA Municipality POLICE 1996100040 Tori, Steve 5/14/2019 I A Open 12,850.38 Adjuster 1 CA Municipality PUBLIC WORKS 9996100014 Kimberly, Lisa 2/17/1999 I A Open 389,523.99 Adjuster 1 CA Municipality POLICE 1896100051 Ryan, Victoria 5/15/2018 I A Open 279,265.79 Adjuster 2 CA Municipality POLICE 9296100125 Linda, Jose 11/9/1992 I A Open 455,804.97 Adjuster 2 CA Municipality ENVIRONMENTAL UTILITIES 2296100222 Keith, Elisa 11/22/2022 M A Open 1,000.00 Adjuster 2 CA Municipality POLICE 2196100064 Kellee, Janet 6/23/2021 I A Open 105,311.35 Adjuster 2 CA Municipality POLICE 2296100205 Kasey, LaDrea 8/16/2022 M A Open 2,525.00 Adjuster 2 CA Municipality LIBRARY 2296100206 Selene, Ryan 9/27/2022 M A Open 1,925.00 Adjuster 2 CA Municipality DEVELOPMENT SERVICES 2296100213 Roderick, Lea 10/5/2022 M A Open 3,735.00 Adjuster 2 CA Municipality POLICE 1696100046 Dolores, Vicente 5/26/2016 I A Open 101,956.71 Adjuster 2 CA Municipality POLICE 2096100133 Gabriela, Juan 12/24/2020 I A Open 145,342.64 Adjuster 2 CA Municipality Fire 1696100083 Thomas, Binita 9/6/2016 I A Open 62,633.00 Adjuster 2 CA Municipality PUBLIC WORKS 2096100057 Angel-Lynn, McKenna 6/11/2020 I A Open 64,326.07 Adjuster 2 CA Municipality POLICE 1996100116 Devin, Jessica 11/20/2019 I A Open 48,810.40 Adjuster 2
CA Municipality Central Services 1196100067 Dinah, Elizabeth 5/26/2011 I A Open 1,221,807.41 Adjuster 2 CA Municipality POLICE 1596100089 Dolores, Cesar 9/3/2015 I A Open 1,130,402.72 Adjuster 2 CA Municipality Fire 1596100090 Amber, Rosemarie 9/3/2015 I A Open 87,958.00 Adjuster 2 CA Municipality POLICE 2096100043 Angel, Krystal 5/3/2020 I A Open 247,417.50 Adjuster 2 CA Municipality POLICE 1996100043 Raul, David 5/19/2019 I A Open 18,222.77 Adjuster 2 CA Municipality LIBRARY 9096100051 Claudia, Alejandra 6/14/1990 I A Open 248,699.11 Adjuster 2 CA Municipality Central Services 9496100133 Lien, April 11/7/1994 I A Open 600,551.43 Adjuster 2 CA Municipality Fire 2296100010 Tate, Frank 9/6/2022 M A Open 1,475.00 Adjuster 2 CA Municipality Fire 1596100020 James, George 2/25/2015 I A Open 133,617.78 Adjuster 2 CA Municipality POLICE 1996100032 Demo - Smith, Carlos 4/15/2019 I A Open 210,697.13 Adjuster 2 CA Municipality Fire 1096100074 David, Cynthia 5/31/2010 I A Open 72,590.38 Adjuster 2 CA Municipality 2296100220 Binita, Rosie 10/27/2022 M A Open 1,325.00 Adjuster 2 CA Municipality Fire 2296100219 Cory, Erika 9/28/2022 M A Open 2,500.00 Adjuster 2 CA Municipality POLICE 2296100216 Cynthia, Michelle 10/10/2022 M A Open 2,425.00 Adjuster 2 CA Municipality POLICE 2296100215 Michelle, Candida 10/21/2022 M A Open 2,175.00 Adjuster 2 CA Municipality POLICE 2296100185 Amanda, Raul 8/9/2022 M A Open 800.00 Adjuster 2 CA Municipality Fire 1796100105 Maximillian, Angelic 12/2/2017 I A Open 180,506.70 Michelle D’Alessandro CA Municipality ECONOMIC DEVELOPMENT 2296100144 Candida, Neysa 5/11/2022 M A Open 9,375.00 Jessica Lopez Grand Totals - 217 Claims
Type Of Claim: None
Totals for None - 217 Claims
Totals for CA Municipality - 217 Claims
CA Municipality Open Claim Log
Valued as of 11/30/2022
Employer: CA Municipality
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 CA Municipality ENVIRONMENTAL UTILITIES 2296100222 Ana, Matthew 11/22/2022 M A Open 1,000.00 Jessica Lopez CA Municipality Fire 2296100223 Abigayl, Ruby 11/24/2022 M A Open 0.00 Jessica Lopez CA Municipality POLICE 2296100215 George, Patricia 10/21/2022 M A Open 2,175.00 Jessica Lopez CA Municipality POLICE 2296100216 Neysa, Angel-Lynn 10/10/2022 M A Open 2,425.00 Jessica Lopez CA Municipality Fire 2296100219 Crystal, Shirley 9/28/2022 M A Open 2,500.00 Jessica Lopez CA Municipality 2296100220 Angelica, Roberto 10/27/2022 M A Open 1,325.00 Jessica Lopez CA Municipality POLICE 2296100224 Jesse, Edgar 11/27/2022 M Open 0.00 Jessica Lopez CA Municipality Fire 2296100221 Arlita, Charlotte 4/7/2022 M Y Open 11,320.00 Stephanie Gonzales CA Municipality Fire 2296100217 Janet, Michael 10/26/2022 I A Open 6,268.08 Stephanie Gonzales CA Municipality Fire 2296100218 Timothy, Cass 10/29/2022 I A Open 14,817.86 Stephanie Gonzales Grand Totals - 10 Claims
Type Of Claim: None
Totals for None - 10 Claims
Totals for CA Municipality - 10 Claims
CA Municipality New Claim Log
Valued as of 11/30/2022
Employer: CA Munitipality
Claim Supervisor Adjuster User Claim Number Claimant Type Of Claim Future Medical? Loss Date Entry Date Date Closed Total Incurred Sample Pool Supervisor 1 Adjuster 1 20080990234 Claimant 1 Indemnity True 12/31/2017 1/30/2018 9/12/2022 1686 30,259.65 Sample Pool Supervisor 1 Adjuster 1 20080990036 Claimant 2 Indemnity True 12/26/2018 1/3/2019 11/18/2022 1415 14,371.71 Sample Pool Supervisor 1 Adjuster 1 20080990003 Claimant 3 Indemnity True 4/30/2019 5/1/2019 10/31/2022 1279 8,093.98 Sample Pool Supervisor 1 Adjuster 2 20080990107 Claimant 4 Indemnity False 7/1/2019 11/20/2019 11/19/2022 1095 46,476.05 Sample Pool Supervisor 1 Adjuster 2 20080990075 Claimant 5 Indemnity False 6/5/2019 1/7/2020 11/30/2022 1058 152,295.73 Sample Pool Supervisor 1 Adjuster 2 20080990248 Claimant 6 Indemnity False 11/8/2019 1/14/2020 9/30/2022 990 70,979.95 Sample Pool Supervisor 1 Adjuster 1 20080990028 Claimant 7 Indemnity True 10/4/2019 3/24/2020 9/30/2022 920 5,591.66 Sample Pool Supervisor 1 Adjuster 2 20080990061 Claimant 8 Indemnity False 12/11/2020 1/25/2021 11/30/2022 674 12,230.00 Sample Pool Supervisor 1 Adjuster 2 20080990037 Claimant 9 Indemnity False 4/15/2021 4/19/2021 10/6/2022 535 17,784.24 Sample Pool Supervisor 1 Adjuster 2 20080990242 Claimant 10 Indemnity False 7/26/2021 8/12/2021 11/30/2022 475 160,380.65 Sample Pool Supervisor 1 Adjuster 2 20080990241 Claimant 11 Medical False 10/17/2021 10/18/2021 9/7/2022 324 4,744.63 Sample Pool Supervisor 1 Adjuster 2 20080990005 Claimant 12 First Aid False 12/26/2021 12/28/2021 9/30/2022 276 0.00 Sample Pool Supervisor 1 Adjuster 2 20080990041 Claimant 13 First Aid False 1/12/2022 1/26/2022 9/22/2022 239 33.59 Sample Pool Supervisor 1 Adjuster 2 20080990011 Claimant 14 Indemnity False 1/9/2022 1/28/2022 10/10/2022 255 3,890.83 Sample Pool Supervisor 1 Adjuster 2 20080990344 Claimant 15 Medical False 1/28/2022 2/2/2022 11/3/2022 274 17,481.30 Sample Pool Supervisor 1 Adjuster 2 20080990076 Claimant 16 Indemnity False 1/5/2022 2/17/2022 10/17/2022 242 11,381.67 Sample Pool Supervisor 1 Adjuster 2 20080990010 Claimant 17 Indemnity False 2/28/2022 3/3/2022 9/22/2022 203 7,033.77 Sample Pool Supervisor 1 Adjuster 2 20080990233 Claimant 18 Indemnity False 3/18/2022 3/22/2022 9/8/2022 170 27,028.58 Sample Pool Supervisor 1 Adjuster 1 20080990201 Claimant 19 Medical False 3/21/2022 3/22/2022 9/27/2022 189 2,664.28 Sample Pool Supervisor 1 Adjuster 2 20080990017 Claimant 20 Indemnity False 5/11/2022 5/12/2022 10/31/2022 172 2,467.89 Sample Pool Supervisor 1 Adjuster 2 20080990016 Claimant 21 Indemnity False 5/15/2022 5/17/2022 9/30/2022 136 13,837.90 Sample Pool Supervisor 1 Adjuster 2 20080990231 Claimant 22 Medical False 5/20/2022 6/7/2022 11/16/2022 162 1,534.63 Sample Pool Supervisor 1 Adjuster 2 20080990032 Claimant 23 Indemnity False 4/11/2022 6/8/2022 10/17/2022 131 13,736.13 Sample Pool Supervisor 1 Adjuster 1 20080990030 Claimant 24 Medical False 6/30/2022 7/14/2022 9/8/2022 56 721.12 Sample Pool Supervisor 1 Adjuster 2 20080990132 Claimant 25 Medical False 7/8/2022 7/14/2022 9/21/2022 69 534.54 Sample Pool Supervisor 1 Adjuster 2 20080990047 Claimant 26 Medical False 7/14/2022 7/18/2022 9/16/2022 60 0.00 Sample Pool Supervisor 1 Adjuster 2 20080990155 Claimant 27 Indemnity False 7/20/2022 7/25/2022 10/19/2022 86 2,437.27 Sample Pool Supervisor 1 Adjuster 2 20080990021 Claimant 28 Medical False 7/20/2022 7/26/2022 9/15/2022 51 843.69 Sample Pool Supervisor 1 Adjuster 2 20080990012 Claimant 29 First Aid False 7/18/2022 7/28/2022 9/29/2022 63 2.00 Sample Pool Supervisor 1 Adjuster 2 20080990157 Claimant 30 Medical False 11/11/2021 8/1/2022 9/21/2022 51 6,743.19 Sample Pool Supervisor 1 Adjuster 1 20080990367 Claimant 31 Medical False 7/27/2022 8/2/2022 10/5/2022 64 1,418.24 Sample Pool Supervisor 1 Adjuster 2 20080990343 Claimant 32 Medical False 4/1/2022 8/3/2022 11/28/2022 117 344.29 Sample Pool Supervisor 1 Adjuster 1 20080990131 Claimant 33 Medical False 8/11/2022 8/16/2022 10/26/2022 71 799.47 Sample Pool Supervisor 1 Adjuster 1 20080990029 Claimant 34 Medical False 8/16/2022 8/18/2022 9/15/2022 28 457.84 Sample Pool Supervisor 1 Adjuster 1 20080990027 Claimant 35 Medical False 8/20/2022 8/23/2022 10/26/2022 64 4.00 Sample Pool Supervisor 1 Adjuster 1 20080990004 Claimant 36 First Aid False 8/15/2022 8/24/2022 10/24/2022 61 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990156 Claimant 37 First Aid False 8/23/2022 8/25/2022 9/2/2022 8 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990133 Claimant 38 Medical False 9/4/2022 9/7/2022 10/26/2022 49 1,560.16 Sample Pool Supervisor 1 Adjuster 1 20080990039 Claimant 39 First Aid False 8/25/2022 9/8/2022 9/30/2022 22 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990038 Claimant 40 First Aid False 9/7/2022 9/13/2022 9/24/2022 11 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990048 Claimant 41 Medical False 9/7/2022 9/13/2022 9/27/2022 14 48.21 Sample Pool Supervisor 1 Adjuster 1 20080990031 Claimant 42 First Aid False 9/8/2022 9/14/2022 9/24/2022 10 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990040 Claimant 43 Medical False 9/5/2022 9/14/2022 10/5/2022 21 279.51 Sample Pool Supervisor 1 Adjuster 1 20080990134 Claimant 44 Medical False 9/8/2022 9/15/2022 9/27/2022 12 583.05 Sample Pool Supervisor 1 Adjuster 1 20080990264 Claimant 45 First Aid False 9/6/2022 9/15/2022 9/30/2022 15 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990116 Claimant 46 First Aid False 9/21/2022 9/22/2022 9/30/2022 8 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990009 Claimant 47 First Aid False 9/21/2022 9/26/2022 10/6/2022 10 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990045 Claimant 48 Medical False 6/30/2022 9/26/2022 10/26/2022 30 309.72 Sample Pool Supervisor 1 Adjuster 1 20080990303 Claimant 49 Medical False 9/20/2022 9/28/2022 10/24/2022 26 481.62 Sample Pool Supervisor 1 Adjuster 1 20080990348 Claimant 50 Medical False 9/26/2022 9/28/2022 10/29/2022 31 925.70 Sample Pool Supervisor 1 Adjuster 1 20080990209 Claimant 51 Medical False 9/22/2022 10/5/2022 10/19/2022 14 1,850.00 Sample Pool Supervisor 1 Adjuster 1 20080990015 Claimant 52 First Aid False 10/1/2022 10/5/2022 10/19/2022 14 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990169 Claimant 53 Medical False 10/5/2022 10/6/2022 10/25/2022 19 179.83 Sample Pool Supervisor 1 Adjuster 1 20080990026 Claimant 54 Medical False 9/30/2022 10/7/2022 10/26/2022 19 195.90 Sample Pool Supervisor 1 Adjuster 1 20080990035 Claimant 55 Medical False 10/4/2022 10/11/2022 10/26/2022 15 356.12 Sample Pool Supervisor 1 Adjuster 1 20080990184 Claimant 56 Medical False 10/7/2022 10/11/2022 10/26/2022 15 38.61 Sample Pool Supervisor 1 Adjuster 1 20080990263 Claimant 57 First Aid False 10/11/2022 10/13/2022 10/19/2022 6 0.00 Sample Pool Supervisor 1 Adjuster 2 20080990022 Claimant 58 Medical False 10/8/2022 10/19/2022 11/28/2022 40 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990208 Claimant 59 First Aid False 10/14/2022 10/21/2022 11/3/2022 13 0.00 Sample Pool Supervisor 1 Adjuster 1 20080990025 Claimant 60 Medical False 10/19/2022 10/24/2022 11/8/2022 15 295.82 Sample Pool Supervisor 1 Adjuster 1 20080990020 Claimant 61 Medical False 10/20/2022 10/27/2022 11/22/2022 26 38.61 Sample Pool Supervisor 1 Adjuster 1 20080990247 Claimant 62 Medical False 8/30/2022 11/4/2022 11/29/2022 25 0.00 Pool Client Claims Closed
Valued as of 12/12/2022
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 20080990328 06/23/2022 RESTRICTED-NT L 06/24/2022 115 Strain or Tea r Finger(s) Edgar, Brianne 20080990317 12/26/2020 OFF WORK 12/27/202 0 659 All Other Cumulative Injur y Multiple Body Parts Lauren, Lauren 20080990290 03/22/2022 OFF WORK 04/29/2022 171 Strain or Tea r Multiple Upper Extremities Charlotte, Nancy 20080990316 05/14/2022 OFF WORK 05/15/2022 155 All Other Cumulative Injur y Brain Kelsey, Norma 20080990278 10/07/2021 OFF WORK 10/08/202 1 374 All Other Cumulative Injur y Circulatory System Lisa, Karen 20080990362 09/09/2022 OFF WORK 09/10/2022 37 All Other (Specific) Injuries, NO C Multiple Body Parts Total Claim Count - 6
CA Municipality (WC)
Claim Log - Work Status
Jan - October 2022

Senior Management Bios

Judy Adlam, who serves as our President and CEO, owns LWP. Judy joined LWP in 1998 following a 22-ye ar career at Fireman’s Fund.

D u r i n g t h a t t i m e J u d y h e l d a p r o g r e s s i o n o f t e c h n i c a l a n d e x e c u t i v e 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, sh e creates the company vision by facilitating an environment of te amwork 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 Prop erty Casualty Underwriter (CPCU) and a Senior Claims Law Associate (AEI). She earned BA degrees in both Psychology and Sociology at Californ ia State University at Northridge, and served six years’ (2007-2013) service on the Board of Directors of the Insurance Education Associatio n (IEA), including two terms as Chair.

Brian joined LWP in 2013 as Vice Pr esident - Claims after 11 years at a national TPA, where he was resp onsible for management and claim operational oversight of 4 California claim locations. He has 27 years of industry experience at both la rge and small third party claims administrators, insurance companie s and an insurance broker. Brian has extensive experience managing claims for self-insured employers (both public and private), clients wi th alternative risk arrangements and fully insured employers and their carriers. At LWP, Brian leads the claims adjusting efforts, with respon sibility 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 Ge neral Insurance certificates. He is a Certified Adjuster under the California Insurance Code and the California Code of Regulations.

Judy Adlam

President and CEO
Brian Esparza

VP - Claims

Page | 1

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 a nd onsite employees within various national Employers, Third Party Administrato rs within our book of business.  Responsible for all quality management oversi ght ensuring customer delivery excellence

Page | 2

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 Universi ty- Bachelor of Science in Nursing (BSN)

accūrō Solutions
Phone: 877.222.8616 ◼ Fax: 412.223.3122
www.accurosolutions.com

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

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 ass istance 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

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
• CA Certified Accountable for the entire LWP
account
• Provider Inquiries
• Represented employer at on site location as
liaison to TPA
• Ability to run and distribute reports
• Medical Legal Review
• Quality Assurance
• Client Service
• Ability to correctly interpret
contract language

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

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 custo mer 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

Veronica Alvarado (Veronica)
Medical Bill Auditor II

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
• 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

Foster City City CouncilJune 16, 2025

Foster City City Council
June 16, 2025