CALCULATION OF AVERAGE WEEKLY WAGES



APPENDIX S

Legal Defense Services

There are differences between the processes used for the COPA WC and WCSF to pay for litigation services. All legal work for the Auto CAT is handled by the Insurance Department.

For the COPA WC, The Commonwealth holds contracts for workers’ compensation legal defense services; there are approximately 10 law firms on contract. The list of law firms will be provided upon award of the contract. The list may change during the term of the contract. The Offeror assigns claims to the firms based on location. The assigned attorney works with the adjuster and the Commonwealth to prepare the case.

Invoices for legal services are submitted to the Offeror, and the Offeror authorizes payments on a biweekly basis after completing the following steps:

1. Verifies that services and charges are billed according to contracted hourly rates, paralegal rates, mileage rates in effect for the period of service, and ensures that the necessary receipts are provided.

2. Enters payment data for invoices into the claims system, assigns a unique tracking number to each invoice, and scans each invoice to the appropriate claim file. Important Note: These payments are not authorized using the same process as other expense payments described in Appendix N – Claim Payment Process.

3. Prepares a report in Microsoft Excel of all authorized payments and submits the Excel spreadsheet and PDF copies of invoices to OA for payment processing.

4. OA is responsible for final review, preparation of payment summaries, and submission to the Treasury Department for payment. OA sends a payment summary to each law firm so that they are able to reconcile the check issued with their files.

Reports of payments made to each law firm as well as reports showing the success of each law firm are required. More information about reports is in Appendix Q - Reports.

For the WCSF, Defense counsel for each claim is assigned by the Workers’ Compensation Security Fund from a list of approved firms. The list of law firms will be provided upon award of the contract and is subject to change during the term of the contract. The assigned attorney works with the adjuster and the WCSF to prepare the case. Refer to Appendix M – Program Forms for a sample of the required form to request outside counsel.

Upon assignment of defense counsel, the Offeror will:

1. Update the computer system to include firm name, case description and details of the final outcome upon conclusion of the litigation.

2. Provide updates to the WCSF by way of status reports and log notes.

3. Verify that the services and charges are billed according to the contractual hourly rates, paralegal rates, mileage rates in effect for the period of service and ensure that all required receipts and documentation are provided.

4. Scan approved invoices to the file and enter them into the claims system using the same process described in Appendix N – Claims Payment Process.

5. All invoices in excess of $1,000 require pre-approval by the WCSF. Such invoices shall be submitted electronically to the WCSF, on a weekly basis, with supporting documentation prior to entering the payment data into the payment interface.

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