1. What Occurs When Your Claims are Submitted to Your Carrier/TPA August 12, 2015

2. Determination of Claim Page | 2

3. Determination of Claim  Accept  Delay & Investigate  Deny Page | 3

4. Determination of Claim Acceptance – explanation of what goes on when claim is accepted.  Facts add up  Start with the end of the story Page | 4

5. Determination of Claim Delay – Investigate  No stone unturned Page | 5

6. Determination of Claim Deny  What will the Audit Unit say?  End of the story? Page | 6

7. Benefits Provided Indemnity & Medical Page | 7

8. Benefits Provided – Indemnity & Medical Indemnity – TTD, PD, SJDV (if applicable)  Benefit calculation  104 weeks…then there’s EDD  Wage garnishments Page | 8

9. Benefits Provided – Indemnity & Medical Medical – MPN, UR, AME/PQME  Asserting treatment within the MPN  Utilization Review…what’s your plan?  IMR…usually favors the employer  Should you AME or QME? Page | 9

10. Issues to Address Page | 10

11. Issues to Address Contribution  Cumulative trauma…pointing fingers Page | 11

12. Issues to Address Apportionment  Prior awards  Pre-existing Page | 12

13. Issues to Address Subrogation  Pay me back  Statue of limitations  Unit Stat filing Page | 13

14. Litigation Page | 14

15. Litigation Defense Attorney  Carrier/TPA panels  Find a good partner Page | 15

16. Litigation Strategy  Settle early v. litigate…make smart business decisions Page | 16

17. Resolution of Claim Page | 17

18. Role of Your Broker Claims Consultant/Analyst Page | 18

19. Role of your Broker – Claims Consultant/Analyst Client advocate on your work comp claims  Understand your company’s dynamics, how it wants claims administered/resolved  Provide alternatives to effectively posture claims toward a quicker resolution  Review reserve setting  Analyze settlement requests for authority Page | 19

20. Role of your Broker – Claims Consultant/Analyst  Collaborate with your carrier/TPA to provide for a better outcome on the claim(s)  Claims Adjuster should be your best friend  Transparency, access to claim information  Assess effectiveness of claims handling Page | 20