WORKERS

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WORKERS COMPENSATION MONITORING
PROGRAMTONY TARAS(800) 782-5888 ext
1678ataras_at_ceo.lacounty.gov
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County Code 5.31.050Workers Compensation System

• Report, investigate, and adjust claims.
• Determine compensability and pay benefits.
• Collect and report statistical data.
• Establish and review reserves.
• Controlworkers compensation costs consistent
  with full provision of benefits under the law.

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TPA CONTRACTS TECHNICAL EXHIBIT I
WORKERS COMPENSATION PROGRAM The primary
objective of this program is to provide all
workers compensation benefits required under
State law to injured County employees on a timely
basis, at the least possible cost to the County.
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TRISTAR RANCHO (UNIT 1)

• MANAGER KAREN SATURDAY
• [phone] ext 1683
• karen.saturday_at_tristargroup
  .net
• MONITORS MARK LEBLANC
• [phone] ext 1648
• mleblanc_at_ceo.lacounty.gov
• TONI VU
• [phone] ext 1769
• tvu_at_ceo.lacounty.gov
  

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TRISTAR RANCHO (UNIT 2)

• MANAGER OLA OLIFESO
• [phone] ext 1152
• ola.olifeso_at_tristargroup.ne
  t
• MONITOR ROSE BLOOM
• [phone] ext 1676
• rbloom_at_ceo.lacounty.gov
• 
  

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INTERCARE (UNIT 3)

• MANAGER KATHLEEN BURRIS
• [phone] ext 430
• kburris_at_intercareins.com
• MONITORS JOE CARRILLO
• [phone] ext 422
• jcarrillo_at_ceo.lacounty.gov
• PAM KENNEDY
• [phone] ext 421
• pkennedy_at_ceo.lacounty.gov
  

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AIMS (UNIT 4)

• MANAGER CHERYL AGEE
• [phone]
• cagee_at_aims4claims.com
• MONITOR ERNIE ROMO
• [phone]
• eromo_at_ceo.lacounty.gov

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The Quality Assurance Evaluator is
a County employee designated as an agent for the
County responsible for monitoring the
Contractors performance, approving over limit
payments, advising and training third party
administrator staff in County payroll systems and
other County procedures. At times this employee
may be referred to as County Monitor.
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DUTIES OF THE COUNTY MONITOR

• Review all delayed claims at 30/60/90 day
  intervals
• Approve all litigation referrals to County
  Counsel
• Approve all award payments
• Approve all payments over 7,500.00
• Provide training to TPA staff

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DUTIES OF THE COUNTY MONITOR

• Assist TPA staff on balancing of complex cases
• Analyze claims and provide settlement
  recommendations and authority
• Address questions and concerns of injured
  workers, County departments, and defense
  attorneys
• Attend claim reviews
• Conduct annual audit of the TPAs

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LIAISON BETWEEN DEPARTMENTS AND THIRD PARTY
ADMINISTRATORS
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CLAIM REVIEWS

• Reviews should be held at least quarterly with
  County Monitors, CEO RTW personnel, Departmental
  RTW personnel, Loss Control, and County Counsel.
• Dont overload! If necessary, schedule more
  frequent claim reviews.

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CLAIM REVIEWS

• File Selection
• Choose files with complex claims or RTW issues.
• Get input from your TPAs, County Monitors, and
  Counsel.
• Out of service does not mean out of sight, out
  of mind!

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CLAIM REVIEWS

• What we need from you
• Information about any RTW efforts that have been
  made
• Information about any disciplinary action being
  taken against the injured worker (unless
  confidential)
• Information about any other action the injured
  worker is taking against the County (unless
  confidential)
• Type of retirement plan
• Out of service date and termination reason, if
  any

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ANNUAL TPA AUDITS

• We randomly select 80 files to audit TPA
  performance during a defined period.
• TPAs are scored on 37 questions assigned weights
  based on level of importance.
• A total score is calculated based on the
  weighted scores in each category.
• There are mutually beneficial performance and
  financial incentives applied based on the total
  score.

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ANNUAL TPA AUDITS

• CHANGES IN 2009
• Vocational rehabilitation questions have been
  eliminated
• New questions on
• State Panel QME Process
• Supplemental Job Displacement
• Work Restriction Letters

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WORK RESTRICTION LETTERS
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QUESTIONS?