Accountability
Call to Story Teller 888-999-1010 left message introducing myself and requesting return call regarding her 09/02/2024 DOI.
What is Claimant Contact?
Phone call to Earl E. Byrd at YouShoesYouLose. Employee returned to work full duty today.
What is Employer/Insured Contact?
CCRX closed: Yes
ISO reports stopped? Yes
Address permanency? Yes 0% (there is no perm in this jurisdiction.)
All known medical bills paid: Yes
MMI date: Claim denied
Exposure for future indemnity benefits: No
Subrogation resolved, if applicable? N/A
Outcomes tile updated in RTW Module (NO errors)? Done
State forms: PA - 496 filed 6/21/2024
Why recommending for closure at this time? No further action necessary at this time.
What is Closure?
This is the note you use to document the overview of medical treatment to date.
What is Medical Management?
4/13/2024 Northwest Community Immediate Care 847-618-9655
48yr old male presented to ICC today with bilateral upper arm pain which started 3 weeks ago. No injury or trauma but does heavy lifting at work. Pain worse with lifting
What is Medical Report Review?
AWW/CR: $624.05/$436.84
Received wage history. $16,225.39 / 26 weeks worked = $624.05 x 70% = $436.84
What is AWW/Comp Rate?
This note type is for an item you must request within 14 days of the referral, and receive from defense counsel within 30 days of assignment and then quarterly as long as the claim is in active litigation.
What is Legal Budget?
This claim is not excess reportable as it does not meet reporting criteria at this time. Deductible is $2mil and reportable at $1mil as set forth by XS Insurance Company.
What is Excess Carrier?
Jurisdiction: Pennsylvania as claimant lives, works in and the injury occurred in PA
What is State/Regulatory Forms?
From: Shields, Brenda
Sent: Tuesday, October 8, 2024 8:49 AM
To: Izzy Gone <igone@lolandorder.com)
Subject: Ophelia Payne DOI 8/1/2024
Do not copy and paste emails, especially email headers, into the file notes in a claim. (Other than for PIE claims where we have direct instructions from the client to do so.) This is a directive from our legal department.
Adjuster response to 2/17/2024 supervisor review:
Correct the errors on the RTW screen-Done
Update the OSHA screen with the providers information-Done
Call the provider to obtain the next appointment date and update the file accordingly. Task set
What is File Review?
Use this note type code for Witness contacts, to address fraud, and Occupation
What is Investigation?
Quilliam T Nibbles, Hedgehog and Whistlepig LLC, 333 Over the Hill Lane, Adventure PA 17908, QTNibbles@Lawforone.com
570-124-6791
Defense counsel assigned, auth provided by client for same. Confirmed defense counsel is on carrier approved panel.
What is Defense Counsel?
Claim review with client (name parties present) 04/29/24 discussed file and agreed to move forward with settlement evaluation once we have received and reviewed the IME report.
What is File Review?
Settlement Evaluations, Settlement Authority, Settlement Agreements, and Settlements approved by the state
** This is NOT a note category. **
What is the SETTLEMENT SCREEN?
When you use the settlement screen to document all settlement activity, CareMC will add a note under the category 'Settlement' in the notes.
CSR/Carrier Report sent to Colleen Card (ccard@xsins.com) XS Insurance Company, next report due 12/15/2024
What is Excess Carrier?
Letter of representation received 02/21/24 from Curtis McPhail, Bickers and McPhail PLC, 1095 Redline, Chicago IL 60663, 773-648-2131 C.mcphail@BMattorneysatlaw.com
What is Claimant Attorney?
This is the note type you would use when providing an overview of litigation to date or to document there is no litigation in your initial data integrity note. This is also where you would put your litigation plan.
What is Litigation?
Is the employee a covered class under this policy? Yes
If Large Deductible customer: XS Insurance Company, Deductible $500,000, reportable at $100,000
What action to take if no coverage/declination? Coverage has been verified.
Job class code number: 0495
Policy number and begin/end dates: 14LM079567 11/1/2023-10/31/2024
Jurisdiction: PA
What is Coverage/Policy?
Reviewed ISO report
6/23/2023 Auto – No injuries noted
6/19/2016 WC Lower leg laceration
5/6/2016 WC Burn
7/3/2016 Auto – Right shoulder strain/cuts/abrasion
12/25/1999 Auto – No injuries noted
7/3/2016 is a matching claim. Sent request for additional details to 3 Orange Risks, Inc. at 1060 W Addison Street, Chicago, IL 60613.
What is ISO Claim Search?
9/27/2024 FCE releases employee to return to work at light duty. Employer cannot accommodate so she is off of work.
Restrictions: Carrying: 20# max occasional carry; Lifting: 20# max occasional lift; Pulling: 20# max occasional pull; Pushing: 20# max occasional push; Walking: No more than 15 minutes of continuous standing/walking followed by 5 minutes of sedentary activity.
**This is NOT a note category. **
Update all return to work information on the Return To Work Screen. You can then Create a Note under "More Options."
CareMC will add a note under the category Work/Disability Status.
Sent request for 501/494C to be filed
Code: IP(W)
Weekly, Monthly, Biweekly payment? Biweekly
Jurisdiction Number: 9205135
Part Of Body: 38. Left upper extremity
Nature Of Injury: 52. Strain
Cause Of Injury: 29. Fall on same level
Narrative/description: EE slipped in parking lot injuring face, left shoulder, left knee and left middle finger
What is State/Regulatory Forms?
Any correspondence (including letters, emails, phone calls) with Defense counsel would be included under this note type.
What is Litigation - Defense Strategy?
Sent request for wage history to Jed Dye at Force Labs, Inc. (j.dye@theforce.com) Requested 52 weeks prior to the DOI.
What is AWW/Comp Rate?
Future Indemnity: Requesting 26 weeks of TTD to pay wages post 10/5/2024 surgery. Total increase: $6,999.20
Medical Treatment: Requesting increase of $160,200 for the 10/5/2024 right hip fracture repair surgery and post op treatment including inpatient hospital/rehab stay, surgery costs, office visits, durable medical equipment, physical therapy and post-operative diagnostic studies.
Expenses: Requesting increase of $28,000 to cover PPO/medical bill review costs, medical copying fees, and medical case management costs.
Total Request: $195,199.20
New total incurred: $204,573.70
What is Reserves?
(Please follow any reserve instructions in the Special Handling Instructions)