Paper
Transaction
Pay methods included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:28:47 AM
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Financial Reconciliation Ledger
Transactions between 12/1/2019 and 12/31/2019
104279 12/31/2019 9/25/2019 11/11/2019 11/11/2019 $82.06 104280 12/31/2019 8/24/2018 12/10/2019 12/10/2019 $166.56 104281 12/31/2019 4/15/2019 07/01/2019 07/01/2019 $875.82 104282 12/31/2019 10/10/2019 11/22/2019 11/22/2019 $134.84 104283 12/31/2019 1/25/2019 12/30/2019 12/30/2019 $98.00 104283 12/31/2019 7/27/2018 12/30/2019 12/30/2019 $98.00 104283 12/31/2019 12/16/1999 12/30/2019 12/30/2019 $98.00 104284 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $130.96 104285 12/31/2019 10/30/2019 10/31/2019 10/31/2019 $7.50 104285 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $7.50 104285 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $3.20 104285 12/31/2019 10/30/2019 11/12/2019 11/12/2019 $7.50 15499 12/20/2019 7/15/2004 07/15/2004 07/27/2004 ($32.57) 93848 12/16/2019 3/1/2016 02/20/2018 02/20/2018 ($10.00) 95567 12/16/2019 3/1/2016 06/12/2018 06/12/2018 ($10.00) 937 $221,300.47
937 $221,300.47
Attending Physician Southern California
Permanente Medical
Check
Surgeon Patrick O'Maley MD Check
Radiology Group Radiology Medical Group
Of Santa Cruz, Inc.
Check
Physical Therapy Align Networks, Inc. Check
Bill Review Athens Insurance
Services, Inc.
Check
Utilization Review Athens Managed Care,
Inc.
Check
Utilization Review Athens Managed Care,
Inc.
Check
Physical Therapy MedRisk Inc. Check
Utilization Review Athens Managed Care,
Inc.
Check
Medical/Legal
Travel
McShane, Cheryl Void
Medical/Legal
Travel
McShane, Cheryl Void
Bill Review Athens Insurance
Services, Inc.
Check
Attending Physician U S HEALTHWORKS
MEDICAL GRP
Refund
Bill Review Athens Insurance
Services, Inc.
Check
Bill Review Athens Insurance
Services, Inc.
Check
Reversals 2 ($20.00)
Total 937 $221,300.47
Payments 933 $221,360.78
Refunds 2 ($40.31)
Total For ABF FREIGHT SYSTEM, INC. Count: Total
Grand Total Count: Total
Payments Amount
Pay methods included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:28:47 AM
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, INC. % Of
Body Part Desc Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc. 90 Multiple Body Parts 9 27 409 0 15 $56,265.77 $212,644.81 $2,083.92 $14,534.15 $156,379.04 15.429 6.145 13.273 90 Respiratory System 0 1 0 0 0 $516.98 $516.98 $516.98 $516.98 $0.00 0.571 0.056 0.032 66 No Physical Injury 0 1 0 0 0 $209.98 $209.98 $209.98 $209.98 $0.00 0.571 0.023 0.013 61 Abdomen 0 4 171 0 43 $30,549.36 $30,549.36 $7,637.34 $24,512.40 $0.00 2.286 3.336 1.907 61 Groin 1 3 229 0 76 $55,562.49 $64,111.75 $18,520.83 $53,950.10 $8,549.26 1.714 6.068 4.002 57 Toe(s) 0 3 91 0 30 $12,086.91 $12,086.91 $4,028.97 $5,115.58 $0.00 1.714 1.320 0.754 56 Foot, Left 1 5 272 0 54 $17,193.49 $35,735.89 $3,438.70 $9,193.20 $18,542.40 2.857 1.878 2.231 56 Foot, Right 0 3 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.714 0.000 0.000 55 Ankle 0 2 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.143 0.000 0.000 55 Ankle, Left 1 4 219 0 55 $22,055.34 $48,750.38 $5,513.84 $18,951.20 $26,695.04 2.286 2.409 3.043 54 Calf Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 54 Leg 0 4 27 0 7 $3,856.29 $3,856.29 $964.07 $3,704.17 $0.00 2.286 0.421 0.241 54 Leg - Right 2 4 302 0 76 $49,073.78 $74,253.83 $12,268.45 $46,914.69 $25,180.05 2.286 5.359 4.635 53 Knee, Left 0 2 103 0 52 $16,410.53 $16,410.53 $8,205.27 $16,410.53 $0.00 1.143 1.792 1.024 53 Knee, Right 4 6 720 0 120 $35,094.07 $65,409.96 $5,849.01 $21,569.95 $30,315.89 3.429 3.833 4.083 51 Hip 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 51 Hip, Left 0 1 8 0 8 $2,868.59 $2,868.59 $2,868.59 $2,868.59 $0.00 0.571 0.313 0.179 51 Hip, Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 49 Heart 1 1 0 0 0 $18.00 $13,000.00 $18.00 $18.00 $12,982.00 0.571 0.002 0.811 44 Rib(s) 1 2 56 0 28 $2,814.66 $3,964.66 $1,407.33 $2,814.66 $1,150.00 1.143 0.307 0.247 42 Lower back area (inc. Lum 0 9 118 0 13 $19,964.18 $19,964.18 $2,218.24 $9,002.09 $0.00 5.143 2.180 1.246 42 Lower Back Area: Lumbar/S 1 4 614 0 154 $58,181.50 $68,500.66 $14,545.38 $53,090.12 $10,319.16 2.286 6.354 4.276 37 Thumb, Left 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 36 Finger(s) 2 4 217 0 54 $33,381.65 $67,484.59 $8,345.41 $22,756.02 $34,102.94 2.286 3.646 4.212 36 Finger(s) - Left 0 2 14 0 7 $1,615.54 $1,615.54 $807.77 $1,615.54 $0.00 1.143 0.176 0.101 36 Finger(s) - Right 1 1 57 0 57 $6,946.00 $15,848.40 $6,946.00 $6,946.00 $8,902.40 0.571 0.759 0.989 35 Hand, Left 0 1 0 0 0 $283.44 $283.44 $283.44 $283.44 $0.00 0.571 0.031 0.018 35 Hand, Right 1 3 133 0 44 $5,531.59 $28,311.79 $1,843.86 $2,939.80 $22,780.20 1.714 0.604 1.767 34 Wrist 0 1 208 0 208 $30,407.11 $30,407.11 $30,407.11 $30,407.11 $0.00 0.571 3.321 1.898 34 Wrist, Right 0 1 0 0 0 $6,852.58 $6,852.58 $6,852.58 $6,852.58 $0.00 0.571 0.748 0.428 31 Shoulder 8 14 1,843 0 132 $202,692.24 $386,836.66 $14,478.02 $80,189.54 $184,144.42 8.000 22.136 24.145 31 Arm 0 1 70 0 70 $10,974.81 $10,974.81 $10,974.81 $10,974.81 $0.00 0.571 1.199 0.685 31 Arm - Left 1 5 229 0 46 $74,071.13 $111,874.46 $14,814.23 $52,825.64 $37,803.33 2.857 8.089 6.983 31 Arm - Right 1 3 4 0 1 $1,513.49 $1,513.49 $504.50 $1,300.84 $0.00 1.714 0.165 0.094 31 Shoulder,Clavicle & Scapu 2 5 314 0 63 $52,690.48 $74,575.90 $10,538.10 $33,858.63 $21,885.42 2.857 5.754 4.655 31 Upper Arm 0 1 6 0 6 $302.13 $302.13 $302.13 $302.13 $0.00 0.571 0.033 0.019 30 Back 6 15 592 0 39 $54,133.84 $104,254.26 $3,608.92 $22,192.34 $50,120.42 8.571 5.912 6.507 30 Multiple Upper Extremitie 1 1 0 0 0 $4,786.72 $15,000.00 $4,786.72 $4,786.72 $10,213.28 0.571 0.523 0.936 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - BodyPart Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:22 AM
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Program Name % Of
Body Part Desc Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc. 20 Multiple Neck Injury 1 1 0 0 0 $18.00 $6,500.00 $18.00 $18.00 $6,482.00 0.571 0.002 0.406 20 Neck 1 2 115 0 58 $26,693.74 $46,626.24 $13,346.87 $26,370.88 $19,932.50 1.143 2.915 2.910 19 Facial Bones 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 19 Forehead 0 1 0 0 0 $292.57 $292.57 $292.57 $292.57 $0.00 0.571 0.032 0.018 18 Face 0 2 0 0 0 $392.00 $392.00 $196.00 $392.00 $0.00 1.143 0.043 0.024 18 Lips 0 1 0 0 0 $628.79 $628.79 $628.79 $628.79 $0.00 0.571 0.069 0.039 17 Mouth 0 1 0 0 0 $366.82 $366.82 $366.82 $366.82 $0.00 0.571 0.040 0.023 14 Eye(s) 0 3 0 0 0 $716.13 $716.13 $238.71 $381.79 $0.00 1.714 0.078 0.045 14 Eye, Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 13 Ear(s) 0 2 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.143 0.000 0.000 10 Head 2 12 41 0 3 $17,642.55 $17,642.55 $1,470.21 $10,361.77 $0.00 6.857 1.927 1.101 Program Name 48 175 7,182 0 41 $915,655.27 $1,602,135.02 $5,232.32 $80,189.54 $686,479.75 100.000 100.000 100.000 Report Total 48 175 7,182 0 41.04 $915,655.27 $1,602,135.02 $5,232.32 $80,189.54 $686,479.75 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - BodyPart Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:22 AM
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Program Name % Of
Injury Cause Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc.
Walking 0 2 103 0 51.5 $16,836.74 $16,836.74 $8,418.37 $16,410.53 $0.00 1.14 1.84 1.05 Vehicle; motor vehicle NOC 0 3 48 0 16.0 $7,817.43 $7,817.43 $2,605.81 $5,087.00 $0.00 1.71 0.85 0.49 Vehicle Accident 1 2 14 0 7.0 $8,982.66 $21,331.66 $4,491.33 $8,696.98 $12,349.00 1.14 0.98 1.33 Unknown 1 1 0 0 0.0 $18.00 $13,000.00 $18.00 $18.00 $12,982.00 0.57 0.00 0.81 Twisting 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Tripped/Fall 0 1 0 0 0.0 $64.90 $64.90 $64.90 $64.90 $0.00 0.57 0.01 0.00 Tripped 1 3 426 0 142.0 $16,803.19 $37,227.34 $5,601.06 $10,361.77 $20,424.15 1.71 1.84 2.32 Struck: Object
Lifted/Handled
0 2 0 0 0.0 $322.86 $322.86 $161.43 $322.86 $0.00 1.14 0.04 0.02 Struck: Obj Handled By
Others
0 2 32 0 16.0 $4,232.50 $4,232.50 $2,116.25 $4,198.69 $0.00 1.14 0.46 0.26 Struck By-Object Being
Lifted or Handled
2 15 324 0 21.6 $55,868.10 $81,634.35 $3,724.54 $33,858.63 $25,766.25 8.57 6.10 5.10 Struck By/Moving Object 0 2 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 1.14 0.00 0.00 Struck by Object 1 3 12 0 4.0 $5,673.22 $10,694.79 $1,891.07 $5,673.22 $5,021.57 1.71 0.62 0.67 Struck by fellow worker 1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Struck By Falling/Flying
Object
4 6 373 0 62.2 $16,670.69 $61,315.77 $2,778.45 $9,193.20 $44,645.08 3.43 1.82 3.83 Struck By Fall'G/Flying
Object
1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Struck against 1 2 0 0 0.0 $485.18 $1,606.35 $242.59 $356.35 $1,121.17 1.14 0.05 0.10 Striking Against - Stationary
Object
0 1 0 0 0.0 $2,342.04 $2,342.04 $2,342.04 $2,342.04 $0.00 0.57 0.26 0.15 Strike; object being lifted or
handled
0 1 104 0 104.0 $24,512.40 $24,512.40 $24,512.40 $24,512.40 $0.00 0.57 2.68 1.53 Strike/Step On Sharp Object 0 2 0 0 0.0 $292.57 $292.57 $146.29 $292.57 $0.00 1.14 0.03 0.02 Strain; strain or injury by,
NOC
1 5 180 0 36.0 $3,183.20 $4,264.48 $636.64 $1,299.43 $1,081.28 2.86 0.35 0.27 Strain; pushing or pulling 4 12 619 0 51.6 $51,609.13 $163,149.64 $4,300.76 $12,668.13 $111,540.51 6.86 5.64 10.18 Strain; lifting 1 7 513 0 73.3 $71,344.40 $128,919.16 $10,192.06 $58,914.83 $57,574.76 4.00 7.79 8.05 Strain Or Injury By Lifting 0 7 71 0 10.1 $12,193.82 $12,193.82 $1,741.97 $9,002.09 $0.00 4.00 1.33 0.76 Strain Or Injury By Jumping 0 1 0 0 0.0 $800.66 $800.66 $800.66 $800.66 $0.00 0.57 0.09 0.05 Strain - Body Motion 2 9 349 0 38.8 $66,973.09 $75,522.35 $7,441.45 $53,950.10 $8,549.26 5.14 7.31 4.71 Strain 0 1 40 0 40.0 $4,804.81 $4,804.81 $4,804.81 $4,804.81 $0.00 0.57 0.52 0.30 Stepped on Object/Sharp
Object
0 1 0 0 0.0 $815.34 $815.34 $815.34 $815.34 $0.00 0.57 0.09 0.05 Stepped On Object 3 3 196 0 65.3 $23,115.54 $62,896.24 $7,705.18 $18,951.20 $39,780.70 1.71 2.52 3.93 Sprain 1 2 480 0 240.0 $22,255.53 $37,666.34 $11,127.77 $21,569.95 $15,410.81 1.14 2.43 2.35 Slip/Fall on stairs 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Slip, Trip, or Fall - Stairs 0 1 0 0 0.0 $3,463.22 $3,463.22 $3,463.22 $3,463.22 $0.00 0.57 0.38 0.22 Slip From Liquid/Grease Spill 0 2 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 1.14 0.00 0.00 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
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Program Name % Of
Injury Cause Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc.
Slip And No Fall 1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Slip And Fall 0 3 216 0 72.0 $33,275.70 $33,275.70 $11,091.90 $30,407.11 $0.00 1.71 3.63 2.08 Repetitive Motion 2 4 65 0 16.3 $19,612.61 $44,889.41 $4,903.15 $7,815.53 $25,276.80 2.29 2.14 2.80 Pushing 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Pulling/Pushing Injury 2 2 188 0 94.0 $22,210.34 $54,624.64 $11,105.17 $22,192.34 $32,414.30 1.14 2.43 3.41 Pulling 3 6 844 0 140.7 $132,313.97 $222,260.15 $22,052.33 $80,189.54 $89,946.18 3.43 14.45 13.87 Misc; other - miscellaneous,
NOC
0 2 0 0 0.0 $209.98 $209.98 $104.99 $209.98 $0.00 1.14 0.02 0.01 Misc; cumulative (NOC) 1 1 0 0 0.0 $14,534.15 $27,000.00 $14,534.15 $14,534.15 $12,465.85 0.57 1.59 1.69 Misc Step On 1 1 285 0 285.0 $46,914.69 $68,772.26 $46,914.69 $46,914.69 $21,857.57 0.57 5.12 4.29 Lifting 1 6 308 0 51.3 $24,429.11 $31,799.09 $4,071.52 $10,974.81 $7,369.98 3.43 2.67 1.98 Lift/Bend/Twist 1 2 574 0 287.0 $53,555.86 $63,875.02 $26,777.93 $53,090.12 $10,319.16 1.14 5.85 3.99 Injured by; object being
lifted/handled
1 2 67 0 33.5 $11,839.78 $11,839.78 $5,919.89 $11,839.78 $0.00 1.14 1.29 0.74 Foreign body in eye 0 3 0 0 0.0 $334.34 $334.34 $111.45 $334.34 $0.00 1.71 0.04 0.02 Foreign Body 0 1 0 0 0.0 $381.79 $381.79 $381.79 $381.79 $0.00 0.57 0.04 0.02 Fall; on same level 0 2 0 0 0.0 $425.70 $425.70 $212.85 $425.70 $0.00 1.14 0.05 0.03 Fall/Slip From Different Level 0 1 0 0 0.0 $3,840.00 $3,840.00 $3,840.00 $3,840.00 $0.00 0.57 0.42 0.24 Fall, slip or trip, NOC 3 6 0 0 0.0 $2,289.03 $20,582.73 $381.51 $1,836.30 $18,293.70 3.43 0.25 1.28 Fall Different Level 0 1 14 0 14.0 $1,934.81 $1,934.81 $1,934.81 $1,934.81 $0.00 0.57 0.21 0.12 Exposure - Noise 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Exposure - Gases, Fumes,
or Vapors - NOC
0 1 0 0 0.0 $516.98 $516.98 $516.98 $516.98 $0.00 0.57 0.06 0.03 Cut; object being lifted or
handled
0 3 8 0 2.7 $1,648.42 $1,648.42 $549.47 $1,281.60 $0.00 1.71 0.18 0.10 Cut/Puncture/Scrape - Obj
being Handled
0 2 0 0 0.0 $283.44 $283.44 $141.72 $283.44 $0.00 1.14 0.03 0.02 Cut,Puncture,Scrape - NOC 1 4 96 0 24.0 $9,423.76 $15,678.15 $2,355.94 $5,210.63 $6,254.39 2.29 1.03 0.98 Cut 0 1 14 0 14.0 $1,615.54 $1,615.54 $1,615.54 $1,615.54 $0.00 0.57 0.18 0.10 Cumulative (All Others) 3 3 0 0 0.0 $4,822.72 $36,000.00 $1,607.57 $4,786.72 $31,177.28 1.71 0.53 2.25 Collision With A Fixed Object 1 1 339 0 339.0 $22,017.92 $31,224.04 $22,017.92 $22,017.92 $9,206.12 0.57 2.40 1.95 Caught; in, under, between,
NOC
1 2 132 0 66.0 $22,756.02 $50,604.57 $11,378.01 $22,756.02 $27,848.55 1.14 2.49 3.16 Caught in or Between - NOC 0 2 21 0 10.5 $3,188.09 $3,188.09 $1,594.05 $2,591.79 $0.00 1.14 0.35 0.20 Caught Between 1 2 111 0 55.5 $56,959.04 $94,762.37 $28,479.52 $52,825.64 $37,803.33 1.14 6.22 5.91 Bending 0 1 16 0 16.0 $2,029.24 $2,029.24 $2,029.24 $2,029.24 $0.00 0.57 0.22 0.13 Animal or Insect Bite 0 4 0 0 0.0 $811.02 $811.02 $202.76 $300.16 $0.00 2.29 0.09 0.05 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
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Program Name 48 175 7,182 0 41.0 $915,655.27
$1,602,135.0
2 $5,232.32 $80,189.54 $686,479.75 100.00 100.00 100.00 Report Total 48 175 7,182 0 41.0 $915,655.27
$1,602,135.0
2 $5,232.32 $80,189.54 $686,479.75
As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
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Payment Type Totals By Program
Category Payments Amount
Program Name
Expense
Investigation
Investigation 23 $37,717.99
Police Report 1 $10.00
Sub-Rosa Invest 1 $1,600.00
Total For Investigation Count: 25 $39,327.99
Legal
Court Reporter Fees 27 $18,205.48
Defense Legal 632 $407,434.85
Deposition Fee 23 $27,440.88
Hearing Representative (Def) 3 $1,515.00
Independent Rating 3 $2,275.00
Legal Copy 1 $990.99
Misc Legal 1 $1,350.00
Subro Legal (Def.) 12 $8,162.30
Total For Legal Count: 702 $467,374.50
Other
Bill Review 4,363 $229,671.99
Copy Expense 207 $26,113.13
IMR Fees 59 $22,383.00
Index - Initial 170 $3,060.00
Medicare Set-Aside Vendor Fees 4 $4,850.00
MSA Vendor Fees 5 $1,212.50
Other 3 $530.96
Travel 7 $198.76
Utilization Review 471 $67,137.00
Total For Other Count: 5,289 $355,157.34
Total For Expense Count: 6,016 $861,859.83
Indemnity
Permanent Disability
Applicant Attorney Fee 21 $56,107.35
C&R Claimant Counsel 9 $67,468.35
Comp & Release 8 $165,151.69
Life Pension 52 $7,321.26
Misc Lien 1 $5,000.00
PD Penalty - On Late 1 $18.91
PD Penalty - Other TPA 19 $1,587.80
Perm.Disability 27 $22,536.63
Perm.Partial Disab. 82 $63,781.42
Stipulated Award 168 $221,313.54
Finding & Award 6 $0.00
Total For Permanent Disability Count: 394 $610,286.95
Rehabilitation\Voucher
Rehab Vendor 1 $9,893.00
SJDB Voucher 3 $7,100.00
Total For Rehabilitation\Voucher Count: 4 $16,993.00
Transactions between 1/1/2019 and 12/31/2019
Totals
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
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Payment Type Totals By Program
Transactions between 1/1/2019 and 12/31/2019
Temporary Disability
EDD Reimbursement 9 $56,908.15
Misc. TD/Wage Loss 2 $1,984.68
TD Adjustment 7 $1,031.56
TD Attorney Fees 1 $311.18
TD Child Support 50 $14,440.80
TD Late: 1st - Athens 1 $161.13
TD Late: 1st - Employer 1 $4.45
Temporary Disability 531 $853,642.69
Temporary Partial Disability 308 $268,653.54
Wage Loss 31 $23,825.68
Total For Temporary Disability Count: 941 $1,220,963.86 Total For Indemnity Count: 1,339 $1,848,243.81
Medical
Medical
Anesthesiolgst 25 $5,456.26
Assistant Surgeon 3 $542.33
Attending Physician 1,358 $171,679.89
Atty Fees: Applicant 1 $7,500.00
Audiology 4 $977.68
Chiropractor 58 $7,225.09
DME 43 $31,025.73
Drugs 235 $16,218.49
Hospital Outpatient 44 $90,823.21
Lien Order -Disputed 2 $3,104.20
Med Reimbursement Claimant 7 $754.67
Medical C&R 5 $228,399.29
Medical Copy 71 $8,268.05
Medical Interpreter 8 $1,088.11
Medical Lien 10 $28,410.00
Medical Supplies 17 $4,182.96
Medical Travel 82 $19,482.86
Medical/Legal Travel 24 $869.45
Medical/Travel Other 1 $18.10
Medicare Trust 1 $87,141.39
ML 101 4 $2,917.69
ML 102 12 $4,375.00
ML 103 7 $5,994.13
ML 106 18 $14,625.00
MSA Fees 7 $4,660.50
Nurse Case Management 24 $15,568.66
Nursing Care 6 $1,575.00
Pain Management Clinic 5 $1,025.57
Physical Therapy 878 $101,537.14
Psychiatric Treatment 43 $4,622.65
QME/Panel 1 $937.50
Radiology Group 166 $22,728.65
Surgeon 80 $91,189.65
Voucher Attending Physician 1 $163.22
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
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Payment Type Totals By Program
Transactions between 1/1/2019 and 12/31/2019
Acupuncture 80 $10,382.49
Ambulance/Transportation 5 $907.80
Medical Legal 6 $1,250.00
Missed Appointment 4 $0.00
ML 104 18 $55,525.92
Pathology/Lab 65 $2,923.09
Total For Medical Count: 3,429 $1,056,077.42
Total For Medical Count: 3,429 $1,056,077.42
Recovery
Recovery
Rec: 3rd Party Subro MED 3 ($161,660.65)
Rec: Excess 4 ($21,489.26)
Total For Recovery Count: 7 ($183,149.91)
Total For Recovery Count: 7 ($183,149.91)
Total For ABF FREIGHT SYSTEM, INC. Count: 10,791 $3,583,031.15 Total 10,791 $3,583,031.15
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
1 of 2
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Activity Period: 1/1/1900 and 12/31/2025
Loss Dates: 1/1/1900 and 12/31/2025
Program Name
Claim Count Claim Type Totals Activity Period: 1/1/1900 and 12/31/2025 Totals on Loss Dates through 12/31/2025 as of 9/10/2020 Open Total Lit FA MO IN Info Paid Incurred Paid Reserves Incurred Avg Claim (excl First Aid) Program Name - Freight System, Inc.
195 5747 961 104 2219 2951 473 $87,677,197.50 $96,944,101.84 $87,677,197.50 $9,266,904.34 $96,944,101.84 $17,176.13 Recoveries ($6,540,129.31) Net Incurred $90,403,972.53
Program Name - Logistics Company
2 124 27 0 58 66 0 $3,613,763.38 $3,810,237.98 $3,613,763.38 $196,474.60 $3,810,237.98 $30,727.73 Recoveries ($1,247,380.24) Net Incurred $2,562,857.74
Program Name. - Trucking Company
1 738 129 16 335 387 0 $16,692,377.45 $16,728,777.94 $16,692,377.45 $36,400.49 $16,728,777.94 $23,170.05 Recoveries ($1,581,302.36) Net Incurred $15,147,475.58
198 6609 1117 120 2612 3404 473 $107,983,338.33 $117,483,117.76 $107,983,338.33 $9,499,779.43 $117,483,117.76 $18,102.00 Recoveries ($9,368,811.91) Net Incurred $108,114,305.85 Grand Total
Open Total Lit FA MO IN Info Paid Incurred Paid Reserves Incurred Avg Claim 198 6609 1117 120 2612 3404 473 $107,983,338.33 $117,483,117.76 $107,983,338.33 $9,499,779.43 $117,483,117.76 $18,102.00 Recoveries ($9,368,811.91) Net Incurred $108,114,305.85 1 of 1
Report run: 9/10/2020 6:28:14 AM
Workers' Compensation Management Summary #9..
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Sample Bordereau with Date Details
Valued As Of Date Program Level2 Level 3 Level 4 Claim Number Claimant Name Status Days Open Claim Type Loss Date Body Part 8/31/2020 Program Name Level2 Level 3 Closed 6663 Major PD 5/23/2002 Lower Back Area: Lumbar/Sacral 8/31/2020 Program Name Level2 Level 3 Closed 1587 Minor PD 4/21/2016 Foot 8/31/2020 Program Name Level2 Level 3 Closed 125 Temporary Disability 4/16/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 61 Temporary Disability 6/24/2020 Multiple Body Parts 8/31/2020 Program Name Level2 Level 3 Closed 61 Temporary Disability 6/23/2020 Ankle, Left 8/31/2020 Program Name Level2 Level 3 Closed 29 Temporary Disability 6/26/2020 No Physical Injury 8/31/2020 Program Name Level2 Level 3 Closed 48 Temporary Disability 6/25/2020 Toe(s) 8/31/2020 Program Name Level2 Level 3 Closed 25 First Aid 11/24/2019 Hand 8/31/2020 Program Name Level2 Level 3 Closed 27 Temporary Disability 7/24/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 17 Info Only 8/10/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 10 Info Only 8/17/2020 Leg - Right 8/31/2020 Program Name Level2 Level 3 Closed 1 Info Only 8/17/2020 Back 8/31/2020 Program Name Level2 Level 3 Closed 5 Info Only 8/21/2020 Foot, Right 13 #9..
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Nature Agent Cause Occupation Examiner Lost Days Indemnity Paid Indemnity Reserves Indemnity Incurred Strain metal items: plates/rods/scrap Pulling/Pushing Injury Not Assigned mdelfin 707 $93,075.69 $0.00 $93,075.69 Contusion fork lift Struck: Obj Handled By Others City Driver mdelfin 325 $76,708.39 $0.00 $76,708.39 Strain Platform/Pallet Strain; pushing or pulling City Driver mdelfin 54 $6,728.48 $0.00 $6,728.48 Strain hand truck Tripped/Fall Dock Worker mdelfin 36 $3,835.95 $0.00 $3,835.95 Strain Bodily Motion Strain; strain or injury by, NOC City Driver mdelfin 24 $3,026.06 $0.00 $3,026.06 Exposure infections/disease/agents Pandemic City Driver mdelfin $0.00 $0.00 $0.00 Laceration hand truck Caught in or Between - Objects Handled City Driver mdelfin 3 $376.83 $0.00 $376.83 Puncture Metal/Wood/Plastic Proc Equip Caught in or Between - NOC Dock Worker jthongdy $0.00 $0.00 $0.00 Strain Bodily Motion Loading/Unloading City Driver mdelfin $0.00 $0.00 $0.00 Strain fork lift Strain; lifting Dock Worker jthongdy $0.00 $0.00 $0.00 Strain Steps Strain; pushing or pulling City Driver jthongdy $0.00 $0.00 $0.00 Strain Platform/Pallet Loading/Unloading City Driver jthongdy $0.00 $0.00 $0.00 Strain ramp Strain - Body Motion Dock Worker jthongdy $0.00 $0.00 $0.00 #9..
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Medical Paid Medical Reserve Medical Incurred Expense Paid Expense Reserves Expense Incurred Total Paid Total Reserves Total Incurred Recoveries Net Incurred $38,861.73 $0.00 $38,861.73 $29,152.48 $0.00 $29,152.48 $161,089.90 $0.00 $161,089.90 $0.00 $161,089.90 $24,672.85 $0.00 $24,672.85 $54,667.29 $0.00 $54,667.29 $156,048.53 $0.00 $156,048.53 $0.00 $156,048.53 $2,554.33 $0.00 $2,554.33 $356.30 $0.00 $356.30 $9,639.11 $0.00 $9,639.11 $0.00 $9,639.11 $1,265.20 $0.00 $1,265.20 $116.72 $0.00 $116.72 $5,217.87 $0.00 $5,217.87 $0.00 $5,217.87 $1,823.05 $0.00 $1,823.05 $178.65 $0.00 $178.65 $5,027.76 $0.00 $5,027.76 $0.00 $5,027.76 $0.00 $0.00 $0.00 $18.00 $0.00 $18.00 $18.00 $0.00 $18.00 $0.00 $18.00 $547.57 $0.00 $547.57 $56.26 $0.00 $56.26 $980.66 $0.00 $980.66 $0.00 $980.66 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $475.71 $0.00 $475.71 $38.33 $0.00 $38.33 $514.04 $0.00 $514.04 $0.00 $514.04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #9..
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(A) (B) (C) (D)
(M)
(G) (H) (I) (J) (K) (L) (1) (2) (4) (5)
20011812 Sergio Ochoa Dock Worker 08/10 0 0
20011814 Arturo Dominguez City Driver 08/10 14 0
20012004 Edward Silvius City Driver 08/14 14 0
20012005 Silvestre Vazquez
Nava City Driver 08/17 6 0
20012070 Nab Hayfron City Driver 08/17 0 0
20012122 Alexander
Ustyuzhin City Driver 08/17 0 0
20012456 Russell Lopez Mechanic 08/17 0 0
20012162 Thomas Torres City Driver 08/19 0 0
20012211 Samuel Krieger Dock Worker 08/21 0 0
20012349 Paul Kautz City Driver 08/24 0 0
20012366 Jose Cervantes City Driver 08/25 0 0
20012455 Batoy Diogenes City Driver 08/26 0 0
20012500 Michael Pallares Yard Worker 08/28 0 0
20012577 Jesus Iniguez City Driver 08/31 0 0
0 3 0 11 34 0 14 0 0 0 Injury Skin disorder Poisoning Hearing loss (1) (2) (4) (5) Respiratory condition
All other
illnesses
(3) (6)
ABF FREIGHT
SYSTEM, INC. Contusion - Finger(s) - Right - Bodily Motion Group Totals 0 0
ABF FREIGHT
SYSTEM, INC. Strain - Lower back area (inc. Lumb./Lumb.-Sac.) - Bodily Motion ABF FREIGHT
SYSTEM, INC. Strain - Multiple Body Parts - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Elbow - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Contusion - Hand, Left - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Multiple Body Parts - ground
ABF FREIGHT
SYSTEM, INC. Strain - Foot, Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Back - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Sprain - Shoulder,Clavicle & Scapula, Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Abdomen incl. groin - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Leg - Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Heel - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Shoulder - Bodily Motion
(6)
ABF FREIGHT
SYSTEM, INC. Strain - Lower back area (inc. Lumb./Lumb.-Sac.) - fork lift
Job transfer
or restriction
Other recordable cases
Injury
(3)
Case no. Employee's name Job title
(e.g., Welder)
Date of injury
or onset of
illness
(e.g.,
month/day)
Where the event
occurred
(e.g., Loading dock
north end)
(E) (F) Using these four categories, check ONLY the
most serious result for each case:
Enter the number of
days the injured or ill
worker was:
Check the "Injury" column or
choose one type of illness: Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill (e.g., Second degree burns on right forearm from
acetylene torch)
Death Days away
from work
Remained at work
Job transfer
or restriction
On job
transfer or
restriction
Skin disorderRespiratoryconditionPoisoningHearing lossAll otherillnesses You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in CCR Title 8 Section 14300.8 through 14300.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you’re not sure whether a case is recordable, call your local Cal/OSHA office for help.
Establishment name
City State
Identify the person Describe the case Classify the case Cal/OSHA Form 300 (Rev. 7/2007) Appendix A
Attention: This form contains information relating to employee health and must be used in a manner that protects the
confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.
Year 2020
Log of Work-Related Injuries and Illnesses Department of Industrial Relations Division of Occupational Safety and Health
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OSHA's Form 300A (Rev. 01/2004)
Summary of Work-Related Injuries and Illnesses
Year 2020
U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no. 1218-0176
All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you¶ve added the entries from every page of the Log. If you had no cases, write 0.
Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA¶s recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total Number of
Deaths
Total number of
cases with days
away from work
Total number of
cases with job
transfer or
restriction
Total number of
other recordable
cases
(G) (H) (I) (J)
0 3 0 11
Number of Days
(K)
34 Total number of days away
from work
Total number of days of job
transfer or restriction
0 (L)
Injury and Illness Types
Total number of...
(M)
(1) Injuries
(2) Skin disorders
(3) Respiratory conditions
(4) Poisonings
(5) Hearing loss
(6) All other illnesses
0 0
0 14
0 0
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW,Washington, DC 20210. Do not send the completed forms to this office.
Establishment name
City State ZIP
Industry description (e.g., Manufacture of motor truck trailers) Standard Industrial Classification (SIC), if known (e.g., 3715 ) Employment Information (If you don't have these
figures, see the Worksheet on the back of this page to estimate.) Annual average number of employees
Total hours worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.
Company executive
Date
Title
Phone
ABF FREIGHT SYSTEM, INC.
Establishment information
dept name ABF FREIGHT SYSTEM, INC.
Street
3801 Old Greenwood Road
Fort Smith AR 72917
Post this Summary page from February 1 to April 30 of the year following the year covered by the form. #9..
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Stewardship Report
2017‐2018 Fiscal Year
As of 5/31/2018
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As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
Claims Entered
672 646
696
745
700
656 686
837
707 719
192 182
227
177 185 183 156 183 173 189
352 334 339
413
371 371 383
486
391 381
128 130 130 155 144 102
147 168 143 149
0 100
200
300
400
500
600
700
800
900
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Claims Entered ‐ 10 Year History
All MO Indemnity Info Only
55%
9% 8%
5% 3% 2%
8%
3% 2% 1% 0% 2%
0%
10%
20%
30%
40%
50%
60%
0 500
1000
1500
2000
2500
3000
3500
4000
% of Total
# of Claims
Claim Reporting Lag Time ‐ 10 Year History
Lag Days % of Total
#9..
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As of 5/31/2018
Cause of Injury # of Delays % of Delayed Claims
Misc. Strain 174 18.0%
Cumulative, Repetitive 135 14.0%
Slip, Trip, Fall 72 7.5%
Pushing, Pulling 69 7.2%
Holding, Lifting, Carrying 62 6.4%
Other than Phy Cause of Injury 58 6.0%
Mental Stress 42 4.4%
Strike, Step on 34 3.5%
Misc. Absorption, Ingestion 32 3.3%
Other 93 9.6%
Occupation # of Delays % of Delayed Claims
Occupation 1 205 21.3%
Occupation 2 160 16.6%
Occupation 366 6.8%
Occupation 457 5.9%
Occupation 557 5.9%
Occupation 649 5.1%
Occupation 747 4.9%
Occupation 820 2.1%
Occupation 919 2.0%
Occupation 10 12 1.2%
Delayed Claims by Occupation ‐ Top 10
Delayed Claims by Cause of Injury ‐ Top 10
Delayed/Denied Claims ‐ Ten Year History
All
All
• Enter Description Here
• Enter Description Here
• Enter Description Here
84 85
71 122
111
84 59
96 120
132
56 76 70
114
87 103
93 119 117 112
0 20
40 60
80 100
120
140
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Delayed Denied
#9..
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As of 5/31/2018
Year # Closed (%) of Total Total Incurred (%) of Incurred Avg. Incurred < 1 Year 594 79.8% $ 1,369,054 10.4% $ 2,305 1 Year 21 2.8% $ 698,061 5.3% $ 33,241 2 Years 22 3.0% $ 422,262 3.2% $ 19,194 3 ‐ 4 Years 41 5.5% $ 3,817,231 29.0% $ 93,103 5 ‐ 7 Years 27 3.6% $ 2,730,542 20.8% $ 101,131 8 ‐ 10 Years 13 1.7% $ 1,350,325 10.3% $ 103,871 11 ‐ 15 Years 16 2.2% $ 1,739,827 13.2% $ 108,739 16 ‐ 20 Years 4 0.5% $ 338,943 2.6% $ 84,736 > 20 Years 6 0.8% $ 680,510 5.2% $ 113,418 Claims Closed in 2017‐18 Year
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
2.4 0.2
0.0 0.5
1.0 1.5
2.0 2.5
3.0 Indemnity Medical Only
Average Claim Age at Time of Closure (Years)
425
144
Closures by Claim Type
Indemnity Medical Only
$30,603
$903
$‐
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
Indemnity Medical Only
Average Incurred Value at Time of Closure
#9..
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As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
Closed Claims
• Enter Description Here
• Enter Description Here
• Enter Description Here
672 646 696 745 700 656 686 837 707 719 661 629 678 719 660 616 619 727 606 537 98% 97% 97% 97% 94% 94% 90% 87% 86%
75%
0%
20%
40%
60%
80%
100%
120%
0 200
400
600
800
1000
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Closed Claims by Year
All Claim Types
10 Year History
Entered Closed (%) of Claims Closed
352 334 339 413 371 371 383 486 391 381 341 317 321 387 331 331 317 376 295 231 97% 95% 95% 94% 89% 89% 83% 77% 75%
61%
0%
20%
40%
60%
80%
100%
120%
0 100
200
300
400
500
600
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Closed Claims by Year
Indemnity Claims
10 Year History
Entered Closed (%) of Claims Closed
#9..
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As of 5/31/2018
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
21.3% 18.9%
9.0% 8.0% 6.5% 5.8% 5.5%
2.4% 2.4% 2.1%
25.7%
10.1% 10.5%
6.2% 6.1% 7.4%
4.8% 6.6%
1.0% 0.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Frequency Analysis by Occupation ‐ Top 10
% of Claims % Costs
0.1%
5.7%
20.6%
31.9% 30.4%
10.7%
0.0% 0.7% 0.0%
2.6%
15.4%
32.6%
36.7%
12.0%
0.6% 0.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
0‐19 20‐29 30‐39 40‐49 50‐59 60‐69 70‐79 80 +
Frequency Analysis by Age
% of Claims % of Cost
#9..
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As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
12.5%
10.5% 10.1%
7.6% 6.9% 5.8%
3.9% 3.5%
7.5% 7.3%
18.1%
10.4%
13.1%
4.3%
2.1%
11.9%
3.4%
5.9%
4.5%
9.3%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0% Frequency Analysis by Cause ‐ Top 10
% of Claims % Costs
47.2%
14.8%
6.2% 2.5% 1.9% 1.6% 1.4% 1.1%
10.5% 6.3%
64.6%
12.1%
3.0% 0.9% 0.1% 0.1% 1.4% 0.3%
6.2%
1.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Frequency Analysis by Nature ‐ Top 10
% of Claims % Costs
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As of 5/31/2018
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
22.3%
16.4%
11.4% 10.4%
7.1%
3.6% 2.9% 2.6%
9.6%
7.5%
18.5%
20.6%
12.0% 10.8%
14.7%
1.6% 1.5% 0.6%
3.1%
13.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Frequency Analysis by Body Part ‐ Top 10
% of Claims % Costs
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As of 5/31/2018
Location 2017‐18 2016‐17 Dollar Variance (%) Variance
Location 1 $ 8,966,649 $ 9,223,143 $ (256,494) ‐3% Location 2 $ 2,769,859 $ 2,284,811 $ 485,048 21% Location 3 $ 78,724 $ 124,603 $ (45,879) ‐37% Location 4 $ 224,715 $ 238,867 $ (14,152) ‐6% Location 5 $ 103,464 $ 73,901 $ 29,563 40% Location 6 $ 3,351 $ 4,837 $ (1,485) ‐31% Location 7 $ 7,854 $ 246 $ 7,608 3096% Location 8 $ 67,968 $ 93,828 $ (25,860) ‐28% Location 95 $ 0 $ 601 $ (551) ‐92% Location 10 $ 60,033 $ 41,459 $ 18,574 45% Total $ 12,282,667 $ 12,086,294 $ 196,373 2% Payout Comparison by Location
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
2017‐18 2016‐17
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As of 5/31/2018
Benefit Type 2017‐18 2016‐17 Dollar Variance (%) Variance Year 1 %Year 2 % Death $ 582,609 $ 119,767 $ 462,842 386.5% 4.7% 1.0% Investigation $ 114,064 $ 117,099 $ (3,036) ‐2.6% 0.9% 1.0% LC 4850 $ 400,906 $ 368,105 $ 32,801 8.9% 3.2% 3.0% Legal $ 707,343 $ 667,251 $ 40,093 6.0% 5.7% 5.4% Medical $ 3,733,885 $ 4,144,172 $ (410,287) ‐9.9% 30.2% 33.8% Other Expense $ 590,665 $ 562,285 $ 28,380 5.0% 4.8% 4.6% Permanent Disability 1,702,975 $ $ 1,687,381 $ 15,594 0.9% 13.8% 13.8% SJDB $ 9,409 $ 7,733 $ 1,676 21.7% 0.1% 0.1% Temporary Disability 4,517,255 $ $ 4,591,773 $ (74,518) ‐1.6% 36.6% 37.4% Total $ 12,359,111 $ 12,265,567 $ 93,544 0.8% Payout Comparison by Benefit Type
• Enter Description Here
• Enter Description Here
• Enter Description Here
1.%
1.%
3.% 5.4%
33.8%
4.6%
0.1% 13.8%
37.4%
2016‐17
Death
Investigation
LC 4850
Legal
Medical
Other Expense
Permanent Disability
SJDB
Temporary Disability
4.7% 0.9% 3.2%
5.7%
30.2%
4.8%
0.1% 13.8%
36.6%
2017‐18
Death
Investigation
LC 4850
Legal
Medical
Other Expense
Permanent Disability
SJDB
Temporary Disability
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As of 5/31/2018
Category 2017‐18 2016‐17 Dollar Variance (%) Variance Year 1 %Year 2 % All Other Medical $ 48,195 $ 98,673 $ (50,478) ‐51.2% 1.3% 2.4% Attending Physician $ 951,130 $ 934,158 $ 16,971 1.8% 25.5% 22.5% Drugs $ 207,325 $ 272,822 $ (65,497) ‐24.0% 5.6% 6.6% Durable Medical Equipment $ 11,939 $ 171 $ 11,768 6884.7% 0.3% 0.0% Hospital $ 155,102 $ 406,629 $ (251,527) ‐61.9% 4.2% 9.8% Hospital Outpatient $ 380,841 $ 446,030 $ (65,189) ‐14.6% 10.2% 10.8% Medical Legal $ 305,841 $ 339,309 $ (33,468) ‐9.9% 8.2% 8.2% Medical Supplies $ 130,663 $ 132,012 $ (1,348) ‐1.0% 3.5% 3.2% Medical Travel $ 64,049 $ 48,862 $ 15,187 31.1% 1.7% 1.2% Medicare Trust $ 202,197 $ 159,924 $ 42,273 26.4% 5.4% 3.9% Nurse Case Management $ 749,113 $ 633,382 $ 115,732 18.3% 20.1% 15.3% Physical Therapy $ 304,376 $ 320,190 $ (15,814) ‐4.9% 8.2% 7.7% Radiology $ 63,154 $ 80,596 $ (17,442) ‐21.6% 1.7% 1.9% Settlement $ 55,276 $ 144,723 $ (89,448) ‐61.8% 1.5% 3.5% Surgeon $ 104,644 $ 126,301 $ (21,657) ‐17.1% 2.8% 3.0% Total $ 3,733,845 $ 4,143,782 $ (409,937) ‐9.9% Medical Detail Payout Comparison
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1.3%
25.5%
5.6%
0.3%
4.2% 10.2%
8.2%
3.5%
1.7%
5.4%
20.1%
8.2%
1.7%
1.5%
2.8%
2017‐18
All Other Medical
Attending Physician
Drugs
Durable Medical Equipment
Hospital
Hospital Outpatient
Medical Legal
Medical Supplies
Medical Travel
Medicare Trust
Nurse Case Management
Physical Therapy
Radiology
Settlement
Surgeon
2.4%
22.5%
6.6%
9.8%
10.8% 8.2%
3.2%
1.2%
3.9%
15.3%
7.7%
1.9% 3.5% 3.%
2016‐17
All Other Medical
Attending Physician
Drugs
Durable Medical Equipment
Hospital
Hospital Outpatient
Medical Legal
Medical Supplies
Medical Travel
Medicare Trust
Nurse Case Management
Physical Therapy
Radiology
Settlement
Surgeon
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As of 5/31/2018
Top 10
Settlements by Amount
Claim # Claimant Name Loss Date Settlement Date Settlement Type Amount 14001881 Claimant Name 1 1/21/2014 10/13/2017 Compromise and Release $ 750,000 94630039 Claimant Name 2 1/11/1994 9/1/2017 Compromise and Release $ 300,000 91853674 Claimant Name 3 3/4/1990 9/1/2017 Compromise and Release $ 300,000 71902552 Claimant Name 4 9/11/1991 9/1/2017 Compromise and Release $ 300,000 12122688 Claimant Name 5 10/29/2002 9/1/2017 Compromise and Release $ 300,000 12010111 Claimant Name 6 10/18/2011 9/1/2017 Compromise and Release $ 300,000 12000881 Claimant Name 7 10/18/2011 9/1/2017 Compromise and Release $ 300,000 11002508 Claimant Name 8 3/15/2011 9/1/2017 Compromise and Release $ 300,000 08000076 Claimant Name 9 4/1/2004 9/1/2017 Compromise and Release $ 300,000 07000992 Claimant Name 10 1/8/2007 9/1/2017 Compromise and Release $ 300,000 • Enter Description Here
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Settlements
$373,314 $1,121,140 $850,939
$169,136
$2,187,203
$5,172,750
$542,450
$3,308,343
$6,023,689
22 23 24 97 3 3 130 61 2 93
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
2015‐16 2016‐17 2017‐18
Claim Settlements
Stipulations C & R Total Cost
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As of 5/31/2018
Year of Loss # Indemnity # Litigated (%) Litigated Litigated Non‐Litigated 2008‐09 381 58 15.2% $ 84,129 $ 11,141 2009‐10 332 65 19.6% $ 116,904 $ 12,775 2010‐11 335 64 19.1% $ 78,212 $ 12,547 2011‐12 414 72 17.4% $ 156,095 $ 11,639 2012‐13 379 81 21.4% $ 104,004 $ 14,410 2013‐14 367 60 16.3% $ 92,210 $ 16,306 2014‐15 405 64 15.8% $ 101,831 $ 14,202 2015‐16 462 84 18.2% $ 107,067 $ 12,665 2016‐17 391 52 13.3% $ 73,742 $ 13,954 2017‐18 355 25 7.0% $ 33,483 $ 12,069 As of 5/31/2018
Location # Litigated Total Claims (%) Litigated Litigated Non‐Litigated Location 1 1 3 33.3% $ 102,570 $ 8,780 Location 2 4 12 33.3% $ 63,766 $ 18,346 Location 3 155 468 33.1% $ 119,846 $ 11,224 Location 4 1 4 25.0% $ 25,453 $ 4,336 Location 5 14 59 23.7% $ 103,844 $ 11,176 Location 6 1 7 14.3% $ 246,015 $ 12,137 Location 7 440 3193 13.8% $ 93,898 $ 13,373 Location 8 9 68 13.2% $ 98,646 $ 14,341 Location 9 0 1 0.0% $ 0 $ 2,229 Location 10 0 2 0.0% $ 0 $ 8,810 Total 625 3817 16.4% $ 100,579 $ 67,135 Ten Year History ‐ Indemnity Claim Litigation
Average Total Incurred
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Average Total Incurred
Ten Year History ‐ Top 10 Locations by % Litigated
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As of 5/31/2018
OPEN CLAIM STRATIFICATION BY INCURRED VALUE
Incurred Value #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred ‐1E+13 $0 ‐ $4,999 43 6.0% $ 100,519 0.1% $ 2,338 5000 $5,000 ‐ $9,999 28 3.9% $ 211,496 0.3% $ 7,553 10000 $10,000 ‐ $24,999 95 13.3% $ 1,573,310 2.0% $ 16,561 25000 $25,000 ‐ $49,999 122 17.1% $ 4,402,476 5.6% $ 36,086 50000 $50,000 ‐ $99,999 176 24.7% $ 13,610,619 17.4% $ 77,333 100000 $100,000 ‐ $149,999 93 13.0% $ 11,564,006 14.8% $ 124,344 150000 $150,000 ‐ $199,999 69 9.7% $ 12,164,456 15.5% $ 176,296 200000 $200,000 ‐ $249,999 28 3.9% $ 6,449,395 8.2% $ 230,336 250000 $250,000 ‐ $499,999 47 6.6% $ 15,566,699 19.9% $ 331,206 500000 $500,000 ‐ $999,999 10 1.4% $ 6,423,396 8.2% $ 642,340 1000000 1M ‐ 2 Million 0 0.0% $ 0 0.0% $ 0 2000000 > 2 Million 2 0.3% $ 6,314,228 8.1% 3,157,114 $ 1E+20 Total 713 100.0% $ 78,380,600 100.0% 109,931 $
OPEN CLAIM STRATIFICATION BY AGE OF CLAIM
Age of Claim #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 ‐ 6 Months 123 17.3% $ 2,195,509 2.8% $ 17,850 6 ‐ 12 Months 56 7.9% $ 2,391,518 3.1% $ 42,706 1yr ‐ 3yr 212 29.7% $ 19,080,677 24.3% $ 90,003 3yr ‐ 5yr 111 15.6% $ 12,015,667 15.3% $ 108,249 5yr ‐ 7yr 66 9.3% $ 15,091,906 19.3% $ 228,665 7yr ‐ 10yr 44 6.2% $ 7,592,462 9.7% $ 172,556 10yr ‐ 15yr 42 5.9% $ 6,177,875 7.9% $ 147,092 15yr ‐ 20yr 35 4.9% $ 5,586,680 7.1% $ 159,619 > 20 yrs 24 3.4% $ 8,248,305 10.5% $ 343,679 Total 713 100.0% $ 78,380,600 100.0% 109,931 $ • Enter Description Here
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Open Claim Stratification
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As of 5/31/2018
OPEN CLAIM STRATIFICATION BY AGE OF CLAIMANT
Age of Claimant #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 0 ‐ 17 Years Old 0 0.0% $ 7,000 0.0% $ 0 18 18 ‐ 20 Years Old 0 0.0% $ 0 0.0% $ 0 21 21 ‐ 25 Years Old 3 0.4% $ 388,457 0.5% $ 129,486 26 26 ‐ 35 Years Old 59 8.3% $ 5,757,907 7.3% $ 97,592 36 36 ‐ 45 Years Old 166 23.3% $ 18,766,609 23.9% $ 113,052 46 46 ‐ 55 Years Old 313 43.9% $ 36,356,796 46.4% $ 116,156 56 56 ‐ 65 Years Old 159 22.3% $ 16,134,905 20.6% $ 101,477 66 66 ‐ 75 Years Old 13 1.8% $ 975,927 1.2% $ 75,071 76 76 + Years Old 0 0.0% $ 0 0.0% $ 0 99999 Total 713 100.0% $ 78,387,600 100.0% 109,941 $
OPEN CLAIM STRATIFICATION BY JOB TENURE
Job Tenure #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 ‐ 6 Months 9 1.3% $ 431,932 0.6% $ 47,992 6 ‐ 12 Months 18 2.5% $ 1,634,562 2.1% $ 90,809 1yr ‐ 3 yr 82 11.5% $ 7,003,563 8.9% $ 85,409 3yr ‐ 5yr 61 8.6% $ 5,445,575 6.9% $ 89,272 5yr ‐ 7yr 75 10.5% $ 7,734,414 9.9% $ 103,126 7yr ‐ 10yr 98 13.7% $ 11,762,368 15.0% $ 120,024 10yr ‐ 15yr 123 17.3% $ 17,287,139 22.1% $ 140,546 15yr ‐ 20yr 105 14.7% $ 9,990,067 12.7% $ 95,143 > 20 yrs 142 19.9% $ 17,090,979 21.8% $ 120,359 Total 713 100.0% $ 78,380,600 100.0% 109,931 $ Open Claim Stratification
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As of 5/31/2018
Type
Severity # Claims Avg. Incurred # Claims Avg. Incurred # Claims Avg. Incurred Low 932 $ 19,061 221 $ 1,874 1,186 $ 15,337 Medium 168 $ 12,853 1 $ 150 169 $ 70,882 High 179 $ 42,319 00 $ 179 $ 220,344 As of 5/31/2018
Claim # Date of Loss Location Occupation PM Score Total Incurred 12003373 12/5/2009 Location 1 Occupation 1 99.5 $ 352,947 07000737 9/25/2012 Location 2 Occupation 2 99.4 $ 406,076 16001672 9/7/2012 Location 3 Occupation 3 99.4 $ 505,158 10000070 6/11/2011 Location 4 Occupation 4 99.4 $ 714,414 11004517 1/15/2012 Location 5 Occupation 5 99.3 $ 354,785 12122669 3/11/2008 Location 6 Occupation 6 99.3 $ 505,854 48504991 1/5/2004 Location 7 Occupation 7 99.3 $ 361,198 11270317 12/19/1998 Location 8 Occupation 8 99.1 $ 464,518 12003316 11/8/2012 Location 9 Occupation 9 99.1 $ 250,994 17212725 10/29/2012 Location 10 Occupation 10 99.1 $ 353,315 • Enter Description Here
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Indemnity Medical Only Total
Top 10 Open Claims By PM Score
$19,061
$12,853
$42,319
$1,874 $0.00 $150
$5,000.00
$10,000.00
$15,000.00
$20,000.00
$25,000.00
$30,000.00
$35,000.00
$40,000.00
$45,000.00
Low Medium High
Avg Incurred
Predictive Model Severity
Average Incurred by PM Severity
Indemnity Medical Only
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As of 5/31/2018
Date of Loss Location Occupation Cause Total Incurred 3/14/2012 Location 1 Occupation 1 Misc; cumulative (NOC) $ 3,253,602 10/31/1991 Location 2 Occupation 2 Misc; cumulative (NOC) $ 3,060,626 12/19/2015 Location 3 Occupation 3 Defensive Tactics $ 983,584 7/7/2009 Location 4 Occupation 4 Fall; on same level $ 746,716 6/11/2011 Location 5 Occupation 5 Fall ‐ Different Level/Elevation $ 714,414 10/24/2002 Location 6 Occupation 6 Fall, slip or trip, NOC $ 680,869 10/14/1985 Location 7 Occupation 7 Lifting $ 657,030 7/9/1980 Location 8 Occupation 8 Misc; person in act of crime $ 575,897 3/17/2012 Location 9 Occupation 9 Act Of Other $ 527,905 11/24/1997 Location 10 Occupation 10 Fall, slip or trip, NOC $ 525,968 As of 5/31/2018
Location Total Dollars Total Claims Avg. $ Per Claim
Location 1 $ 309,803 288 $ 1,076 Location 2 $ 169,404 1656 $ 102 Location 3 $ 419 4 $ 105 Location 4 $ 396 66 $ 6 Location 5 $ 161 32 $ 5 Location 6 $ 43 14 $ 3 Location 7 $ 27 21 $ 4 Location 8 $ 12 43 $
Location 9 $ 0 0 $ ‐ Location 10 $ 0 0 $ ‐ As of 5/31/2018
Claim # Location Body Part Date of Birth Total Dollars 7000737 Location 1 Multiple Body Systems & Body Parts 9/11/1951 $ 217,259 12003057 Location 2 Knee 7/15/1964 $ 33,019 16001672 Location 3 Upper Arm, Left 1/6/1982 $ 19,536 16001129 Location 4 Shoulder(s) 9/4/1954 $ 12,859 48505479 Location 5 Multiple Body Systems & Body Parts 1/26/1960 $ 11,923 91845504 Location 6 Lower Back Area: Lumbar/Sacral 11/7/1938 $ 11,120 13004066 Location 7 Toe(s) 1/25/1975 $ 9,167 75608300 Location 8 Multiple Body Systems & Body Parts 4/19/1927 $ 7,740 11004517 Location 9 Multiple Body Systems & Body Parts 10/11/1948 $ 7,458 19212043 Location 10 Multiple Neck Injury 3/27/1962 $ 7,346 Top 10 Open Claims By Incurred Value
Open and Closed Claims ‐ Top 10 Claims by Pharmacy Spend between 2016‐18 Top 10 Locations by Pharmacy Spend between 2016‐18
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Athens Administrators
Workers’ Compensation Best Practices
1. Caseload
All Claims Examiners will have reasonable caseloads taking into account the type of claims and the level of service requirements. The optimum number of active indemnity claims for a Senior Examiner is 150. Future Medical caseloads should not exceed 250. The supervisor will not carry a caseload.
2. Claim File Documentation
All claims activity, including correspondence, plans of action, referrals, reserve rationale, claim status reviews, medical and legal referrals, emails and approvals will be clearly documented in the computer notepad. A copy of all written documentation, notices, letters, reports, etc., will be maintained in the claim file as electronic attachments.
3. Coverage
The Athens claims team will verify coverage for each claim and document that verification in the claim notes. If applicable, Athens will exercise due diligence in joining applicable co-defendants. All activity to verify coverage and join co-defendants will be clearly documented in the computer notepad.
4. Forms and Attachments
Each file will include a copy of requiredforms,includingthe Employer’sReport of Injury,DWCForm1, benefit notices, awards, settlement documents,medical reports, panel requests, URreferrals,investigative reports and legal correspondence. Athens will send the employee the DWC Form 1 if the employer has not provided one to the injured worker.
5. Claim File SetUp
Upon receipt of the Employer’s Report of Occupational Injury or Illness or Application for Adjudication of Claim, Athens will set up an individual claim file within three business days. Preparation of the claim file will include entering each new claim into the computer system and establishing a claim number.
6. Diary Review
All claim files will have a future diary review depending on the type of claim. Active indemnity claims will be reviewed every 30 to 60 calendar days for active claims and at least every 180 calendar days for claims that have settled but are open for the employee’s future medical care. Supervisory reviews are performed every 90 days for active indemnity claims and every 180 days for future medical claims.
7. Employer Contact
Athens examiners will contactthe employer within 48 hours of notice of claim. The examiner will confirm the detailsandfactsofthe claims, collect additional information,determine workstatus,identify witnesses,and #9..
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provide initial information back to the employer. The employer contact will be documented in the claim file notes.
Phone calls will be returned within one business day. All correspondence from employers will be responded to within five business days of receipt.
8. Employee Contact
Telephonicpersonal contactwill beestablished withtheinjuredemployee withintwo businessdaysof receipt of notice of claim on all non-litigated, lost time cases. The examiner will discuss entitlement to benefits and the options available to the claimant should they disagree with the benefit decision. The examiner will also encourage the claimant to contact Athens with any questions once they receive their benefit notices. Such contact will continue as often as necessary, but at least monthly on all non-litigated claims as long as the injured worker is off work. Such contact with the employee will be clearly documented in the computer notepad.
As required,Athens will confer with and assistinjuredemployees in resolvingproblems that arise frominjury or illness claims.Examiners will return phone calls ofunrepresented employees within one business day.
Examiners will respond to correspondence from employees within five business days of receipt. Upon claim resolution, Athens will contact unrepresented claimants to discuss the resolution of their claim and address any remaining issues.
9. Reserves
Appropriate reserves will be established within three business days based on the information available.
Reserve rationale will be documented in the claim file.
Reserves will be established based on the facts of the claim and should reflect the ultimate probable cost of the claim. All reserve categories will be reviewed on a regular basis but not less than at least every 90 calendar days. Such detailed reviews will be clearly documented in the computer notepad.
10. Medical Management
The treating doctor’s office will be contacted within three business days of notice of all new claims to obtain medicalstatusanddiscussreturntofullormodifiedwork.Athenswillmaintaincontactwithtreatingphysicians to ensure that the injured worker receives proper medical treatment and is returned to full or modified duty atthe earliestpossibledate.The resultsofthis contact will be clearlydocumented inthe computernotepads.
Athens will arrange medical evaluations when needed, reasonable, and/or requested in compliance with the current California Labor Code.
Athens will ensure that medical bills are reduced to the Official Medical Fee Schedule (OMFS) and recommended rates established by the Administrative Director of Workers’ Compensation.
Athens will make referrals for utilization review (UR) and/or professional managed care services on an asneeded basis in accordance with UR approved guidelines.
Telephonic and field nurse case management will be assigned when appropriate and with the approval of the employer. Results will be closely monitored and assignments will be promptly terminated if the nurse is unable to or is no longer adding value. Task assignments will be made whenever possible to control unnecessary costs.
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Medical Provider Networks (MPNs) and Pharmacy Benefit Management (PBMs) services will be utilized as agreed upon with the employer.
11. Medical Payments
Medical bills will be reviewed for accuracy, approved for payment on the appropriate claim file, and paid within time limits established by Labor Code Section 4603.2. If all or part ofthe bill is being disputed, Athens will notify the medical provider, on the appropriate form letter, within time limits established by Labor Code Section 4603.2.
12. Plan of Action
A current plan of action will be included in the file notes. The plan of action on new claims will be developed within fourteen calendar days of initial claim set-up. Such plan of action will be clearly stated including the reasoning, strategy, and course of action(s) for the plan. The plan of action will be updated every 90 calendar days for active indemnity claims and every 180 days for future medical claims.
13. Future Medical Claims
Claims that remain open to monitor future medical care only will continue to be monitored for appropriate medical treatment and potential settlement. Claims will be reviewed every 180 days. The claim notes will include settlement information, an outline of future medical care, potential excess reporting, and reserve rationale.
Athens will evaluate the claim at least annually to determine a reasonable amount for settlement of future medical benefits and any remaining benefits due.
14. Investigation
All indemnity claims will be reported to the Index Bureau. ISO results will be reviewed for prior injuries, potential co-defendants, and possiblefraud.
Claims will be promptly investigated when red flags are identified. The scope of the investigation will be determinedbyfactsandinformationobtained.Outsideinvestigativefirmswillbeusedforstatements,factual investigations and sub rosa.Authorization for investigation will be obtained fromthe employer or client, and all activities will be clearly documented in the computer notepads.
15. Fraudulent Claims
Any claim with suspected fraudulent activity will be referred to Athens’ special investigation process for further investigation and potential referral to the District Attorney.
16. Compensability
The compensability determination (accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination will be made and documented in the file within fourteen calendar days from the employer’s date of knowledge of the claim. Delay of benefit notices will be mailed in compliance with the Division of Industrial Relations’ guidelines. Copies of benefit notices will be maintained in the applicable claim file.
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17. Provision of Benefits
Athens will provide all compensation and medical benefits in a timely manner and in compliance with statutory requirements. Benefits will be computed and paid to injured employees based upon earnings information and authorized disability periods.
18. Initial Indemnity Payment
The initial indemnity payment or voucher will be issued and mailed to the injured employee along with a properly completed DWC notice within fourteen calendar days of knowledge of the first day of disability.
Copies of benefit notices will be maintained in the applicable claim file.
Self-imposed penalties must be entered by a Claims Supervisor.
19. Subsequent Indemnity Payments
All indemnity payments or vouchers subsequent to the first payment will be verified and paid every two weeks. Copies of benefit notices issued with subsequent benefits will be maintained in the applicable claim file.
Self-imposed penalties must be entered by a Claims Supervisor.
20. Return to Work
Athens will assist the employer in establishing a modified work program that is appropriate for injured employees while recovering and prior to their return to regular duties.
Athens will consult with the employer on a regular basis in those cases where the injury might involve permanent work restrictions and/or disability retirement potential. This contact will be documented in each claim file.
Athens will notify the employer immediately upon receipt of an employee’s permanent work restrictions so thatthe employer can determine the availability of permanent modified or alternative work. Notification will clearly be documented in the computer notepad.
All applicable benefit notices will be sent to the employee as required by the California Labor Code. Copies of benefit notices will be maintained in the applicable claim file.
21. Transportation Expense
Transportation reimbursement will be reviewed for accuracy, approved for payment, and paid timely.
Advance travel expense payments will be mailed to the injured employee at least ten working days prior to the anticipated date of travel.
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22. Permanent Disability
Athens will provide information to and assistinjured employees in completing the necessary forms to obtain a permanent disability evaluation or rating. Athens will contact eachunrepresentedemployee with potential permanent disability, discuss the level of permanent disability and address any questions or concerns.
Athens will determine the nature and extent of permanent disability and arrange for an informal disability rating whenever possible to avoid Workers’ Compensation Appeals Board (WCAB) involvement. Athens will address and pursue any potential apportionment to prior claims, disabilities, and impairments. Athens will also advise the employer of potential credits and increases to permanent disability benefits based upon the employer’s ability or inability to accommodate permanent/alternative work for at least twelve months.
All permanent disability benefit notices will be sentto the employee as requiredby theCalifornia LaborCode.
Copies of benefit notices will be maintained in the applicable claim file.
23. Litigated Cases
The legal aspect of all cases will be timely and appropriately evaluated. Examiners will justify the need for defense counsel and will obtain the employer’s authorization and consent prior to referring claims to legal.
When defense counsel is not necessary, Athens will work closely with the applicant’s attorney to attempt informal resolution and avoid unnecessary litigation costs.
Athens will maintain control of claims referred to defense counsel and will direct counsel to avoid unnecessary costs. Activities that are within the examiner’s scope of expertise (such as scheduling appointments, subpoenaed records requests and file and serve letters) will remain the responsibility of the claims examiner and/or assistant examiner.
Athens will prepare clear and concise litigation referrals to outside counsel outlining the issues of the claim and duties that will be handled by defense counsel. An initial litigation budget will be requested at the time of referral. Defense counsel will clearly outline a written plan to defend the litigated issues and provide an estimated litigation budget, a written initial analysis and subsequent written updates timely. The employer will be kept informed of outside counsel’s progress.
Athens will monitor outside counsel’s progress and will audit all defense counsel’s bills before payment is authorized. Athens will confirm the defendant is properly named on all legal documents.
When preparing for trial, Athens will confer with the employer, so that all material evidence and witnesses are utilized to obtain a favorable result.
24. Settlements
Athens will seek settlement authority from the employer. All requests for settlement authority will include a written claim summary, estimate of permanent disability, and the defense counsel’s comments and recommendations, if any.
Every settlement must consider appropriate use of a Medicare Set Aside (MSA) with documentation to support the decision whether or not to proceed with an MSA. Athens will identify an approved vendor to prepare and submit the MSA for approval.
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25. Subrogation
Athenswillpromptlyinvestigatecaseswithsubrogationpotential.Inallcaseswhereathirdpartyisresponsible for theinjurytotheemployee,Athenswill requestauthorityfromtheemployer topursuesubrogation.Athens will contactthe responsible party withinten businessdaysofidentification andnotify themofthe employer’s rightto subrogation and the recovery of certain claim expenses. Ifthe third party is a governmental agency, a claim will be filed with the governing board within six months of the injury or notice of injury.
Periodic contact will be made with the responsible party and/or insurer to notify them of the amount of the estimated recovery for which we will be seeking reimbursement.
If the injured worker brings a civil action against the responsible party, Athens will discuss the value of the subrogation claim and other considerations with the employer to determine the best course of action. Upon authorization from the employer, subrogation counsel will be assigned to file a Lien or a Complaint in Intervention in the civil action within the applicable Statute of Limitations.
Whenever practical, Athens will attempt to resolve the civil claim and the workers’ compensation claim together, by means of a Third-PartyCompromise and Release. If such attempt does not succeed, every effort will be made to obtain a credit to offset future claim expenses when the case in chief is settled before the WCAB.
Athens will obtain approval from the client for all subrogation waivers.
26. Vocational Rehabilitation/Supplemental Job Displacement Benefits (SJDB) In accordance with all applicable California Labor Code and Regulation requirements, Athens will:
A. Determine the Qualified Injured Worker/Non-Qualified Injured Worker status B. Advise the injured worker of his/her right to rehabilitation benefits/SJDB C. Provide appropriate vocational rehabilitation benefits/SJDB D. Control rehabilitation/SJDB costs
E. Attempt to secure the prompt conclusion of vocational rehabilitation benefits/SJDB F. Promptly provide notification to the employer should work restrictions require permanent or modified, alternative accommodations
27. Excess Insurance
Cases with potential to exceed the self-insured retention will be timely reported to the excess carrier in accordance with the carrier’s reporting criteria.
28. Excess Reimbursement/Subrogation Recovery
Athens will be responsible for collecting reimbursements and recoveries from the excess carrier and appropriate third party on a quarterly basis. A copy of the request for reimbursement will be maintained in the claim file.
29. Overpayments
Athens will attempt recovery of overpayments on all files. Attempted recovery will be documented in the claims file. Credit may be taken, when allowed, against future benefits. #9..
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30. Award Payment
Award payments will be issued within 20 calendar days of the approved settlement. Late payments will include the self-imposed increase and appropriate interest in accordance with the Labor Code.
31. Penalties and Self Imposed Increases
Late payment of all benefits mustinclude the self-imposed increase,in accordance with California law, upon verificationthatafullyexecutedDWC-1formisonfile.Athenswillprovidetheemployerwithaquarterlylisting of any administrative penalties/increases and will identify the party responsible for the penalty/increase. If the penalty/increase was the responsibility of Athens, Athens will issue a reimbursement check payable to the employer.
32. Case Closure
All cases will be closed within sixty calendar days ofthe final financial transaction or final correspondence to the injured worker, as required by law. Future medical cases will be closed within 60 days following two full years of financial inactivity, except in cases where future treatment is reasonably anticipated.
33. Claims Reporting
Athens will assist in the preparation of all reports that are now, or will be, required by the State of California or other government agencies. Athens will also assistin the preparation of all reports or databases required by statistical database organizations, or as requested by the employer. Costs associated with custom data programming may be charged to the employer with the employer’s prior agreement.
34. Claim Supervision
Athens claim supervisors will regularly review the work product ofthe claims examiners. The Supervisor will review all new claims within the first thirty days of receipt from any source. Active indemnity claims will be reviewed by the supervisor no less often than every 90 days. Such reviews will include redirection, recommendations and/or appropriate feedback, which will be clearly documented in the computer notepad.
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4/28/2021 Page 1
To Our Valued Legal Partners:
Athens Administrators values a strong and collaborative relationship with our defense counsel. As legal counsel, trusted to handle matters on behalf of Athens Administrators, we feel it is important for you to understand Athens Administrators case handling philosophy and billing rules.
We have developed these Guidelines and Rules to ensure our claims professionals as well as our legal partners possess an awareness of our case handling requirements. Please familiarize yourself with these guidelines and communicate them to any counsel and/or staff who may be involved in the defense, billing or administration of Athens Administrators cases.
Please note that our Guidelines and Rules have been carefully drafted to provide you with specific guidance on our expectations for your work and billing for all legal assignments referred to you by Athens Administrators.
We also are pleased to have you note that wherever possible our Guidelines and Rules contain similar requirements and expectations as found in the Defense Research Institute (DRI) “Recommended Case Handling Guidelines for Insurers” and the Council on Litigation Management (CLM) “Litigation Guidelines.” Athens Administrators expects to work with defense counsel to achieve the best result in an efficient and costconscious manner consistent with the law firm’s ethical obligations. Thus, nothing contained herein is intended to nor shall restrict or otherwise interfere with any ethical directive governing the conduct of counsel.
Athens Administrators intends to utilize consistent processes to facilitate prompt and appropriate responses to all cases. Identifying obstacles early and moving matters to resolution is our primary objective. We expect that counsel will work together with our claims professionals to define what a successful resolution is for each specific matter and to work efficiently to reach that resolution.
We believe that our Guidelines and Rules are relatively simple and straightforward. However, should you have any question on any part of the Guidelines or Rules, please feel free to consult with Sunny White, Athens Administrators Division Manager.
Litigation Guidelines
Representation and Billing
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Guidelines on Legal Representation
Initial Referral
Cases will be referred by the claims examiner with a letter explaining the referral, any pleadings and pertinent file material, and their views on resolution of disputes in the claim. The letter is intended to explain the basis for the referral and outline of disputes.
• Case Acknowledgement: Within five business days after assignment of a new case, counsel should acknowledge receipt of the assignment by e-mail. Counsel should also address any matters of immediate concern and/or information that may result in early resolution of the case.
Counsel should take the necessary steps to preserve our position on disputed issues. Counsel should review the claim materials and provide an initial file review.
• Initial File Review and Budget: Within ten business days after receipt of the claims file, counsel should provide a comprehensive review to include coverage and liability, medical outlook, further handling recommended by Athens, and further handling recommended for counsel. This review should include the disputed issues to be resolved, any issues of law, most realistic outcome for each disputed issue, key opportunities for resolving all disputed issues, and legal services that will pursue resolution of disputed issue. The budget should include all activity reasonably anticipated to achieve final resolution of the claim.
Conflicts of Interests: At counsel’s expense, counsel is also required to complete a conflict of interest review immediately upon receipt of the assignment. Counsel is required to affirmatively confirm that no conflicts exist and that the firm is able to handle the matter. Counsel must continue to review conflicts throughout the representation. Any conflict identified is to be reported immediately via phone and e-mail to the claims examiner and claims supervisor. Requests for a waiver must be via e-mail and must contain a clear description of the conflict, scope of the contemplated representation and scope of the waiver. All waivers for conflicts of interests must be approved by the claims supervisor prior to beginning substantive work on the assigned matter.
Philosophy of Staffing
A file should be assigned to a dedicated attorney, rather than the law firm. The attorney to whom the file is assigned should be the person who communicates with Athens Administrators, who attends depositions, hearings and pre-trial conferences, and who tries the case. In essence, Athens Administrators requires that attorney be responsible for the entire case until the case is closed or until a mutual decision is made to involve other counsel. Reassignment within the firm is not allowed without advance written approval of Athens and XXXX.
Law firm will provide a dedicated attorney list/spreadsheet to Athens Administrators quarterly along with the quarterly legal report.
Use of Associates & Paralegals: Wherever possible, lower billing personnel (such as associates and paralegals) should be used to promote efficiency and cost effectiveness. As such, a partner should not perform work more appropriately assigned to a lower billing associate and neither a partner nor an associate attorney should perform work more appropriately assigned to a paralegal. Similarly, a paralegal should not be assigned secretarial or other clerical tasks. This tracks with an attorney’s ethical duty and settled case law on using lower billing or even non-billing personnel whenever possible to do so.
As Athens Administrators must approve the use of billing staff in advance, please let the claims examiner know which associate or paralegal may be used to assist the attorney assigned a case and why it would be beneficial to use the associate or paralegal. Please note that if certain associates or paralegals are approved to do work in the files, it is expected that they will continue to work on the case as needed throughout the life of the case. Therefore, their work should not be reassigned to other associates or paralegals in the firm except for reasons beyond the #9..
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firm's control. In this regard, please note that work reassignments necessitated by vacation schedules or the need for approved staff to work on other client files would not be considered beyond the firm’s control.
Use of Administrative/Clerical Support: Work which can be performed by administrative assistants or support staff are overhead firm expenses and should not be billed to Athens Administrators. Examples of administrative and clerical work include, but are not limited to,
• Receiving and distributing mail,
• New file set up or closing file activities,
• Maintenance of office and attorney calendars and schedules, • Transcribing, copying, Bates-stamping, posting, faxing, emailing copies of documents, and inserting documentsinto the file,
• Retrieving documents from a file,
• Communicating with vendors including copy services, subpoena services, interpreters, or court reporters,
• Communicating with court clerks, medical offices, or other law offices for the purpose of scheduling, • Checking an electronic or court database or calling court clerk to check on status of a matter, • Routine recurrent tasks otherwise considered as overhead such as: processing bills, word processing and faxing,
• File assembly, organization or maintenance activities, • Updating lists, and
• Preparing acknowledgement letters or cover letters which contain no substantive information including letters to court clerks with documents for filing.
Planning & Budgeting
Athens Administrators places great emphasis on the planning process and believes it is vital to ensure a highquality, cost-effective legal defense in each and every file. A sound legal defense is the objective of counsel and Athens Administrators and should be developed in a timely manner.
Case Work Plan: Once an objective has been established for the file, counsel must draft a case work plan to meet the objective along with a case budget. This litigation work plan and case budget should be completed within 10 business days of the assignment. The case work plan contains key work tasks that counsel and the claims examiner agree best meet the goal of successfully resolving the matter according to the agreed to objective. See Appendix for a sample Case Work Plan/Case Budget Worksheet form to be used as a guide in preparing the case work plan.
Please note that it is important the case work plan include specific dates when certain tasks are to be completed.
The case work plan should also include key report dates as required by the claims examiner. The case work plan should consider reasonable contingencies and be updated or changed as information is developed or subsequent circumstances dictate. When changes in the case work plan need to be made, counsel will need to make sure the claims examiner is involved and agrees to the changes.
As part of the referral, a case budget is to be established on each matter consistent with the litigation work plan.
The budget should reflect when the anticipated expenses for various stages of the litigation process will occur.
The case budget should track with the case work plan prepared. Please see the Case Budget portion of the Case Work Plan in the Appendix and use it as a guide in developing a case budget plan for your assignment.
Negotiation: Athens Administrators seeks a successful resolution of all contested matters. When an opportunity for counsel to negotiate presents itself, counsel should contact Athens Administrators at once and obtain settlement authority from the claims examiner before beginning negotiations. Athens Administrators also welcomes Counsel’s ideas and insights on how negotiations might successfully resolve the assigned matter.
Settlement documents and any additional language increasing exposure for the District require Athens #9..
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Administrators oversight and approval. This includes negotiations to mitigate liens and any release of third party liability for subrogation, co-defendants, contribution and apportionment.
Penalties: Counsel should immediately advise the claims examiner when counsel is aware of any exposure to penalties. Counselshould also provide recommendations to the claims examiner regarding resolution of any penalty issue. Counsel must obtain authorization from the claims examiner to resolve any penalty. Authority to resolve a penalty may only be issued by the claim supervisor. It is the responsibility of the claims examiner to obtain authority from claims supervisor before issuing authority to counsel. Counsel must confirm with the claims examiner that the claims supervisor has agreed with the authority issued prior to extending any offers or resolving any penalty. Authorization to try a penalty must come from the claims supervisor directly.
Communications
Unless otherwise directed, all communications including reporting should be sent to the claims examiner, claims supervisor, XXXX and the WC claims consultant. All correspondence should include a caption with the name of the claimant and claim number(s), along with document type label. As to attachments, the document type label is to be clearly listed on the documents first page.
Initial Report: Counsel’s initial report should be provided as a part of the case work plan which is due 10 business days from the receipt of the file. In providing the required information, counsel should not include lengthy recaps of what is already in the Athens Administrators file in counsel’sinitial report.
Interim Status Reports: Athens Administrators discourages “rote reporting” every 30 or 60 days. It is expected that subsequent planning conversations will be event driven rather than time driven. These should be conducted upon occurrence of any event that may significantly impact liability, damages or the budget, with revised plans of action submitted to the claims examiner. Counsel is expected to keep the claims examiner informed on essential items as the assigned matter progresses. In the event that there has not been any progress within 90 days, an e-mail to the claims examiner should be sent stating that there has not been any change in the status since the last report and what, if anything, can be done to move the matter along. Interim status reports should cover only the activity since the previous report. Normally, interim status reports should be driven by events (e.g., a hearing) and should be set out in the case work plan. Reporting on routine information (e.g., acknowledgement of service) should be done in the next interim status report.
Significant Development Report: Counsel should communicate and apprise Athens Administrators of significant developments within 48 hours or as soon as practical. If applicable, the report should include counsel’s opinion on whether the case work plan or the case budget should be changed due to the significant development.
Calendars and Caseload Report
Counsel should provide their monthly calendars to the claims supervisor, XXXX and WC claims consultant every 1st of the month. Counsel should provide their quarterly caseload reports to Athens Administrators within the first week of the ending quarter.
Litigation Review
Litigated claim reviews are scheduled quarterly. Defense counsel will prepare a proper report of the claim file to include demographics, current matters on calendar, case summary, outstanding issues/liens, exposure/settlement potential, and recommendations to conclude matter, estimated legal fees, and additional comments. Defense counsel will attend claim reviews in person to present the claim file and litigation strategy. Reports are due 14 days #9..
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prior to the claim review. Counsel should provide follow-up plan of actions 30 days after every litigation review to Athens Administrators claims supervisor.
Requests
Upon receipt of requests from XXXX and Athens Administrators, counsel shall send acknowledgement within 24 hours and provide a timeframe to produce the information requested. Counsel should copy the claims examiner on all correspondence directed to anyone other than the examiner.
Discovery
Athens Administrators has found that the majority of defended cases are resolved without the necessity of trial. Consequently, it is generally preferable to target discovery to only that which will enhance the client’s position or enable a better job of evaluating and settling the case early on without the necessity of preparing for a trial.
Also, some cases have claim files that are quite developed. In such cases, Athens Administrators may require little, if anything else, to be able to evaluate the claim and negotiate a settlement. Thus, counsel’s assistance may simply be required to protect the answer date and advise Athens Administrators on due dates or to obtain certain information via the discovery process.
Interrogatories, Requests for Admission: Athens Administrators normally requires unsummarized copies of information received through interrogatories and requests for admission. If there is a need to call something to the attention of the claims examiner, it should be briefly stated in an e-mail. Entire documents should not be summarized unless asked to do so.
Depositions, Independent Medical Exams: Depositions must be conducted with a specific goal and defense theory in mind. Aimless or misdirected depositions are unacceptable. Even though they are provided for in the case work plan, counsel must check with the claims examiner before actually scheduling or taking depositions or requesting an IME for the injured party. The necessity of each deposition and IME must be considered in light of the status of negotiations, exposure, and probable outcome.
Ordinarily, counsel’s notes taken at depositions and mental impressions of the witnesses will suffice for reporting and evaluation purposes and are expected to be submitted within 7 days following the deposition. When a verbatim summary of a deposition is prepared, Athens Administrators views this as a task that a competent paralegal can complete.
Counselshould discuss potentialsettlement opportunities with the claims examiner 14 days prior to all depositions.
The claims examiner will need 14 day notice to prepare settlement authority request prior to deposition.
Settlement of claim at deposition is a desired outcome.
Pleadings, Motions, & Research
Transmittal of Pleadings & Other Documents: Counsel should provide to Athens Administrators copies of pleadings, including amended pleadings and motions, or deposition transcripts. Counsel shall send copies of all settlement demands. When transmitting requested pleadings and other documents to Athens Administrators, counsel should do so with just a simple no substantive cover letter or e-mail from counsel’s legal assistant which merely identifies the documents. There is no need to dictate a substantive cover letter unless a significant development has occurred in the interim that should be brought to the attention of Athens Administrators. It is not necessary to summarize the pleadings. If Athens Administrators has questions about the pleadings or documents, the claims examiner will contact counsel.
Motions: Counsel should consult with the claims examiner before filing any motions not previously identified and #9..
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approved in the initial case work plan or any supplements thereto.
Research: Counsel should consult with and get approval from Athens Administrators before undertaking a legal research project that will take one hour or more to complete. Copies of all research memoranda shall be provided to Athens Administrators upon request.
Experts & Outside Investigators; Site Inspections; Outsourcing Athens Administrators policy is to use its claims examiner to investigate claims. Athens Administrators only uses outside investigators under unusual circumstances, and then such use requires advance approval. The use of surveillance and sub rosa investigations also requires advance approval from Athens Administrators.
Occasionally, a consulting engineer, independent medical examiner, or other expert is required for a good defense. Athens Administrators appreciates counsel’s recommendations and welcomes referrals to experts counsel has used successfully. Athens Administrators must authorize experts before counsel employs them. Prior to their retention, all experts and investigators need to submit budgets for approval to the claims examiner.
Pre-approval isrequired for all site inspections. Also, outsourcing of legal work without prior approval from Athens Administrators will not be permitted or reimbursed.
Hearing/Trials
Authority to proceed to trial must be secured from XXXX’s WC Consultant. A legal analysis of the issues should be sent to the claims examiner, claims supervisor, XXXX, and claims consultant. No later than 15 days prior to the expected start date of a hearing or trial, Athens Administrators requires that counselsubmit a pre-trial report.
Counsel should notify the claims examiner of a settlement conference, court appearance, trial or hearing as soon as the date is set. Counsel should contact the claims examiner in advance of the court date to discuss issues to be addressed, review pertinent discovery, obtain authority and discuss anticipated outcome. Within one business day of a settlement conference, award issuance, or qualifying order, counsel will provide communication to claims examiner, and in all other instances within three business days. The reporting should include: events of the hearing and their impact on the case, a summary of any testimony presented and its impact on the case, counsel’s impression of any witnesses, evidence submitted, issues addressed, outcome and recommendation for further handling. During any workers’ compensation trial, counsel must communicate with the claims examiner at least once during each trial day, and provide a recap at the end of each trial via email.
Settlements and Awards
Counsel should communicate all awards, settlements, findings, minutes of hearing, and orders within 24 hours to the claims examiner, claims supervisor, XXXX and WC claims consultant. The email communication should include that there is an order, award or stipulation to pay attached along with the amount due, supporting calculation, the date the payment is due, the tax I.D. and mailing address of the payee (when applicable), beginning and ending dates of the period covered (when applicable). Recommendations for appeal, exposure and likelihood of success on appeal should be included when applicable. #9..
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Billing Rules
Billing Review Standards
Athens Administrators has taken care to see that all of the substantive Billing Rules mirror counsel’s ethical duties pursuant to the applicable professional conduct rules and settled case law.
Expectations of Counsel in Charge
Athens Administrators will construe each billing statement for fees and costs as a representation by the counsel in charge of the assigned that the counsel has reviewed the billing statement and has determined it accurately reflects work and expenses reasonably and necessarily incurred; the statement directly relates to the matter listed; and the fees and chargesreflected in the statement comply with Athens Administrators Rules.
Counsel’s Retention of Documents
Counsel shall maintain for review by Athens Administrators any documentation, receipts, etc. in support of all disbursements for 2 years after the file was closed by the law firm. Original time sheets for any Athens Administrators files should be retained for at least 2 years after the final closure of the file by the counsel or firm.
Billing records should be maintained and available to permit a determination of total hours billed per individual on any given day. Any billing information contained in the original time sheets relating to a non-Athens Administrators matter (including the names of other clients and any billing entries for work performed on those other matters) may be redacted. However, the time billed on non-Athens Administrators matters should not be redacted.
Athens Administrators Right of Review and Audit
Billing to Athens Administrators must be supported by the underlying work product in the file. A copy of all such work product will be made available to Athens Administrators upon request. We reserve the right to review all charges for services and disbursements pertaining to the matter.
A copy of file work product will also be made available to any auditor retained by Athens Administrators for the purposes of a file audit. It will be at the discretion of Athens Administrators whether your legal bills will be audited periodically or on a monthly basis, by an auditing firm.
Payment of legal bills and expenses on a file does not constitute a waiver of our right to request reimbursement resulting from an evaluation or audit of your firm’s bills. Athens Administrators reserves all rights to decline to pay or to seek reductions and/or refunds with respect to charges that fail to comply with the Guidelines and Rules as set forth herein and which are not fully explained or documented by the firm after reasonable inquiry. Athens Administrators shall allow the law firm to appeal any declination of payment. Athens Administrators agrees to pay the undisputed portion of bills received from counsel within 30 days.
Arbitration
In the event of a dispute between retained defense counsel and Athens Administrators as to accuracy, reasonableness, or necessity of any charge for fees or costs, the dispute should be amicably and promptly resolved through discussions directly between defense counsel and Athens Administrators. If a dispute cannot be resolved by such discussions, the parties agree that the dispute shall be submitted to binding arbitration. The parties shall mutually select a single neutral arbitrator, or, if they are unable to agree, each party shall appoint one arbitrator and the two arbitrators shall, in turn, appoint a third, impartial arbitrator. No matter how the arbitrator(s) is/are chosen, the arbitrator(s) must have experience in arbitrating fee bill dispute claims. The decision of the arbitrator(s) shall be final and binding with no right of appeal. The cost of the arbitration shall be borne by the losing party or in such proportions as the arbitrator(s) may decide.
Billing for Professional Fees
Agreed Hourly Rates: Athens Administrators will pay fees at the agreed hourly rates for professional services (i.e., only those services that require the skill or the acumen of an attorney) by approved attorneys. Athens #9..
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Administrators will also pay the fees of paralegals who are performing professional services that would normally be performed by an attorney in the absence of a paralegal. The agreed upon rates in effect at the commencement of the matter will remain the same to the conclusion of the file, unless Athens Administrators agrees in writing to a change. All requests for a change in fees shall be directed to the Athens Administrators claim supervisor.
Fees for Travel Time: Athens Administrators agrees to pay 50% of the billing rate for all approved travel time outside counsel’s local area. Counsel’s local area is defined as any travel within 25 miles (one way) of counsel’s office.
Fees and expenses for travel within a 25 mile radius of counsel’s office will not be paid.
Fees for Research: Athens Administrators will not pay for legal research considered to be routine or elementary including research on issues considered to be common knowledge among reasonably experienced counsel in the counsel’s local area. Athens Administrators also expects counsel to utilize previously prepared research whenever possible. Although Athens Administrators will not pay for research (or any other work) previously prepared for other matters, Athens Administrators will pay for that portion of the research that updatesthe work product.
Where research is appropriate in an assigned matter, counsel should consult with and obtain the approval of Athens Administrators before undertaking a legal research project requiring over one hour of research time. When billing for research time of one hour or more, please note in the billing entry the name of the claims examiner who authorized the research project. Copies of all research memoranda shall be provided to Athens Administrators upon request. Athens Administrators will not pay the costs for Lexis, Westlaw or other electronic or computer assisted research.
Reviewing & Summarizing Medical Records: It is expected that the initial review and summary of all medical services records from providers such as hospitals, physicians, therapists, pharmacies, etc. will be done by a competent paralegal. Where an attorney does the initial review and summary of medical records, the attorney billing rate will be reduced to a paralegal billing rate. Counsel should consult with and get approval from Athens Administrators before undertaking a legal research project that will take one hour or more to complete. Copies of all research memoranda shall be provided to Athens Administrators upon request.
In billing for review and summary of medical records from providers, the billing entry should include the following information: the name of each provider, a description of each provider’s records reviewed, the number of records (including pages) reviewed, and the time for the review of each provider’s records. Billing entries lacking this information will be considered as lacking “adequate descriptions.” Also, it is recognized that multiple copies of the same medical records may be produced through different sources including through the claimant (either informally or through formal discovery), the claimant’s attorney, or the medical services provider by way of third party discovery. When copies of the same records are provided, Athens Administrators will only pay for the summary of one set of the medical records and will not pay for multiple summaries of the same medical records.
Task Itemization and Charges: All billing entries shall be based on the actual time taken to complete a function/task by counsel or the paralegal performing the task or function. With hourly fee billing, only time charges in increments of .1 of an hour will be permitted. Where Athens Administrators detects that a counsel is engaging in form or pattern billing (e.g., charging a minimum amount of time for all task or for specific tasks such as phone calls, letters, etc.), Athens Administrators reservesthe right to reject all such charges and reassign its files.
The time charge for a service that takes less than .1 of an hour will be zero or no charge (NC). A task such as a telephone call that is 3 minutes or more may be rounded up to .1 of an hour (or 6 minutes), while a legal task that takes less than 3 minutes such as listening to or leaving a telephone message (LMTCB) or reviewing a file marked copy of a document filed by counsel should be rounded down to zero or no charge. Time billed in excess of .1 hour (or 6 minutes) can similarly be billed by rounding up or down to the nearest higher or lower increment.
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prohibited. The only exception would be where a series of small related tasks (e.g., reviewing a short letter from opposing counsel, drafting a reply, and then e-mailing the claims examiner about the letter or reviewing several short documents), each taking less than .1 of an hour to perform, are grouped together in order to be able to bill .1 of an hour. Block billed entries in a bill will not be paid.
Adequate Descriptions: All billing entries for professional services must include an adequate description of the legal task or service performed as it is impossible for Athens Administrators to determine the reasonableness of the fee or the task unless the task is adequately described. This requirement mirrors an attorney’s ethical duty to adequately describe tasks in their legal bills. See Statement of Principles, ABA Lawyer Task Force on Lawyer Business Ethics (1996) (“Each invoice should clearly identify the legal services provided in such specificity as the client requests.").
Below are examples of “incorrect” and "correct" descriptions of a billed for service:
Example: Incorrect: Letter to counsel.
Correct: Letter to opposing counselsetting out proposed terms of settlement.
Similarly, such entries as “reviewed documents” or “attention to file” would be considered vague and inadequate descriptions without an explanation of what documents were reviewed (and their relevance to the matter if not readily apparent) or what specifically was done in providing “attention to the file” (and its relevance to advancing the file if not readily apparent). Inadequately described entries in bills will not be paid.
Non-Reimbursable Fees
Athens Administrators will not pay as reasonable, fees billed by attorneys or paralegals for the following:
Billing individual fees and chargesfor documents(e.g., notices orsubpoenas) prepared for multiple parties when only one document is prepared.
More than .1 hour for preparing pre-printed or computer generated forms, documents, letters, pleadings, notices, discovery, settlement agreements, etc., where only basic information (e.g., names, addresses, court information, amounts,and dates) is added. More than .1 hour for preparing all documents necessary to request one set of medical records from an employer, hospital, doctor, pharmacy, etc.
Trial or hearing preparation work including preparation of arguments, trial notebooks, exhibits, etc. when a hearing or trial is not imminent.
Initial summaries of medical records by attorneys, unless billed at paralegal rates. Work that could have been performed by Athens Administrators personnel unless approved in advance by Athens Administrators.
Time billed to perform a task that takes less than .1 hour to complete such as time billed to listen to a recorded phone message or time billed to leave a recorded phone message or draft a brief cover letter or e-mail.
Excessive time to revise or edit documents or multiple reviews of the same documents by one attorney or a review of the same document by multiple attorneys. Fees resulting from inappropriate staffing (e.g., partners performing research, associates drafting chronologies, and paralegals performing tasks that non-billing legal secretaries/clerks can do).
Intra-office conferences unless preauthorized.
Time spent on supervision including providing instructions to staff or receiving reports on assigned work. Attendance by more than one attorney at any deposition, conference, trial or other hearing without prior approval from the claims examiner.
Any file review or any work done when the file is transferred to a new attorney. Research in excess of one hour, unless previously authorized by Athens Administrators. #9..
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Comprehensive file reviews other than by the primary attorney. Charges for preparation of bills and/or negotiation of disputes or overbills. Administrative services including secretarial and clerical functions. Fees to check or resolve conflicts.
Fees for filing documents with a court or administrative tribunal. Work performed by employees other than approved attorneys and paralegals. Extraneous fees incurred on a case after the date of settlement. Attorney or paralegal time spent on preparation of budget or on invoice and audit preparation and responding to billing inquiries.
Staff overtime charges.
File opening and/or closing charges.
Fees for out of state travel that has not been pre-approved. Fees that cannot be substantiated by attorney daily record slips or timesheets.
Billing for Costsand Expenses
Reimbursement Policy: Subject to the policies and procedures set out infra, Athens Administrators will reimburse counsel for all reasonable and necessary expenses incurred in handling the assigned matter at the actual net cost to counsel or the law firm. Copies of receipts in support of all billed for costs and expenses should be submitted by counsel to Athens Administrators. Counsel should pay individual invoices under $500 and include any disbursement (with receipt) on the firm’s next invoice. Individual invoices over $500 may be sent to Athens Administrators for payment.
Legal Costs: Counsel is requested to send Athens Administrators any invoice for payment of approved legal costs (e.g., expert witness fees, court reporters) for direct payment by Athens Administrators. Where counsel pays an approved legal cost, a copy of any paid invoice for which reimbursement is sought from Athens Administrators must be included with the legal bill.
No Mark-ups or Surcharges: Unless approved by Athens Administrators in advance, Athens Administrators will only pay for the actual net cost (after deducting for any discount) to counsel or the law firm of the billed for cost or expense. Examples: if counsel uses a “temporary” lawyer or paralegal to do approved work on the assigned matter, Athens Administrators expects to be billed on an hourly basis based upon the actual hourly costs for the temporary employee as billed to counsel; if a copy service or court reporter provides counsel a discount or reduced rate, such discount or reduction will be passed along to Athens Administrators. In-house photo-copying will be reimbursed at 10 cents a page. Number of pages and the documents to which the copies apply must be included on the invoice.
Travel: Athens Administrators will reimburse counsel for necessary and reasonable travel expenses outside counsel’s local area (i.e., over 25 miles one way). Athens Administrators will not pay for any out of area travel expenses including meals/airfare/hotel charges unless pre-approved by Athens Administrators. Out of area overnight or day travel should be at the lowest available fare booked 14 days or more in advance, unless notice is not received within this time frame. It is expected that counsel will seek the best rates for air travel, hotel, car rental and meals. Entertainment, dry cleaning or other non-essential charges will not be reimbursed.
Receipts must be submitted to Athens Administrators for all travel expenses. Luxury (first class) travel and accommodations are not reimbursable as reasonably incurred expenses.
The following below outlines Athens Administrators policies regarding reimbursable travel expenses:
Air Travel: Coach Fare
Ground Transportation: Taxi’s and ride sharing services (such as Uber and Lyft) are preferable over rental car, unless rental car will result in cost savings Rental Car: Intermediate Size Car
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Lodging: Reasonable business accommodation. No additional charges for hotel amenities such as in-room movies, in-room bar charges, dry cleaning, or fitness clubs
Meals/Beverages: Reasonable meal cost. No reimbursement for alcoholic beverages.
Express Mail and Messenger Services: Athens Administrators will not pay for express mail, overnight delivery, outside courier or messenger service unless Athens Administrators requests it, or as the result of an emergency not of the law firm's making. If these items are billed, an explanation must be provided.
Pre-Approved Costs and Expenses
Pre-approval is required on the following disbursements in order to be considered for reimbursement:
Consultants,
Expert Witnesses (including IME’s),
Surveillance’
Imaging,
Overnight travel,
Volume photocopy charges (in excess of 100 pages).
Non-Reimbursable Costs and Expenses
Athens Administrators will not pay as reasonable, costs billed for the following:
Mileage in excess of the current IRS rate for mileage reimbursement, Charges for facsimile transmissions other than the appropriate long distance charges for the transmission,
Normal (regular) postage,
Computerized research such as Westlaw or Lexis,
In-house messenger service to deliver/pick-up documents to other offices, courts, etc. Routine expenses otherwise considered as overhead such as: local telephone bills, word processing and faxing.
In-town (i.e., within 25 miles one-way or 50 mile radius) automobile rentals.
Billing Format
The billing format must include the following:
Heading - The first page of the bill must be prepared with entries stating:
Caption,
Law firm’s IRS number,
Name of the claimant,
Claim number,
Time period for which the bill applies.
Body - The bill must be prepared with entries showing:
Date the work was performed,
Initials of the person providing the service,
Description of the work performed (single activities), Actual time in 1/10th of an hour increments, and
Dollar cost of the work.
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Example of line item entry to be used in legal bill:
Date ID DESCRIPTION TIME COST
2/10 JC Review of opposing counsel’s 1/30/16 demand letter. .2 $30 End of Bill Summary - Must include:
Full name of each timekeeper with initials used in legal bill, Level of each timekeeper (i.e., partner, associate, paralegal), Hourly rate for each timekeeper,
Total hours and total amount charged for each timekeeper during the billing period, Total billed to date on the file including current billing, Any paymentsreceived on the case, and
Balance due on the file.
When task coding is required by Athens Administrators, counsel should use the uniform billing codes as endorsed by the American Bar Association and the Association of Corporate Counsel.
Split Billings: When work can be performed for other clients while also performing work on the assigned Athens Administrators matter, Athens Administrators would expect only to be billed for a proportionate share of counsel’s time. Such situations commonly arise when making court appearances, when waiting for depositions or meetings, or in other circumstances where delays are common.
Any time split between more than one file, including work billed to other clients, or other carriers where joint defense agreements are established, either within the same matter or within the same series of matters should be split between the files at appropriate ratios. Any time split between files must state: total time split, numbers of files for which the time was billed; and time allotted to each file.
Cumulative Totals: Each legal billsubmitted for payment is to include a cumulative total of the amount billed to date on the case and also reflect the budget established for the case.
Billing Schedule: Unless other arrangements have been agreed to, counsel may submit bills to Athens Administrators on a 30 day basis via mail. Resolved cases must be final billed within 20 days of resolution #9..
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APPENDIX
Case Work Plan/Case Budget Worksheet
• Case caption
• [Other identifying information such as name of claimant] • Claim or file number
Case Work Plan
TASKS TARGET DATE
(E.g., Visit the accident scene at store location;
photograph the sprinkler heads; provide photos to
building code expert for an opinion whether the
height of the sprinklers conformed to the Code or was
a de minimus variant.)
Visit & photograph by 1-07-
20;
Obtain expert opinion by 3-
30-20
(E.g., File a Notice of Deposition of claimant; Depose
Claimant.)
File Notice by 3-25-20;
Deposition by 4-25-20.
(Note: List of tasks can be expanded.)
Case Budget (Excluding trial expenses)
ITEM AMOUNT
Estimated length file will remain open: # months
Depositions $
Medical Records $
Mediation $
Travel $
Filing Fees $
Other
ESTIMATED TOTAL
$
$ 0.00
Notes:
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LICENSE NUMBER: 2743958
Issue Date: 03-29-2007 Expiration Date: 05-31-2022
Independent Adjuster
ATHENS INSURANCE SERVICE, INC.
DBA: ATHENS INSURANCE ADMINISTRATORS
2552 STANWELL DRIVE
CONCORD, CA 94520
is authorized to transact business as described above
License No: 2743958 Issue Date: 03-29-2007 Expiration Date: 05-31-2022 Generated by Sircon 212340380
THIS IS TO CERTIFY THAT
ATHENS INSURANCE SERVICE, INC.
DBA: ATHENS INSURANCE ADMINISTRATORS
2552 STANWELL DRIVE, CONCORD, CA 94520
IS HEREBY AUTHORIZED TO TRANSACT BUSINESS
IN ACCORDANCE TO THE LICENSE DESCRIPTION
SHOWN BELOW:
Independent Adjuster
Generated by Sircon 212340380
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Evaluation Criteria
Possible
Points
Athens
Admin.
Innovative
Claims
Intercare
Insurance
Pegasus
Risk
Manag.
Sedgwick
Claims
Manag.
Tristar
Insurance
References 15 14 11 12 15 7 11
Specific Requirements 35 34 27 31 28 28 29
Programs 15 14 13 13 11 12 11
Third-Party Administrator Questionnaire 15 14 12 13 11 11 11 Cost 20 17 20 16 17 16 16
TOTAL 100 92 83 85 81 73 79
Ranking (# according to score highest to lowest) 1 3 2 4 6 5 Workers' Compensation Claims Management Program
Scoring Abstract
Project No. 2021-44
4/27/2022
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