We utilize a dedicated Workers’ Compensation Unit to maximize responsiveness to employees and meet their needs so they can return to work. The unit has dedicated examiners, claims assistant supervisors, nurse advocates, and medical directors. They control costs through treatment management and timely communication with all parties.
We promote a “Zero Litigation Philosophy” that ensures employees receive quality care and timely benefits without the necessity of legal intervention. In the event legal counsel becomes necessary, the Workers’ Compensation Defense Panel ensures members have quality representation at the various appeals boards.
CIRA maintains a comprehensive litigation management program. The objective is to assign cases to law firms that are most qualified to handle the defense while producing the best outcomes and ensuring cost-efficient representation without compromising the quality of that representation. Firms are selected based on demonstrated success in defending public entities.
Sr. Claims Examiner
Basics of Workers’ Compensation Guide– CIRA developed this guide as a best practices template so members can assist administrative personnel, supervisors, or others with a role in overseeing the workers’ compensation process at the agency level.
Claims Administrator Guidelines– The requirements for Third Party Claims Administrators were designed to ensure consistent handling, reflect current practices, and to comply with with industry best practices.
Workers’ Compensation Litigation Guidelines – Litigation Guidelines establish a clear understanding of the expectations and requirements of CIRA. Nothing contained in the guidelines is intended to hinder defense counsel’s ability to exercise their professional judgment or interfere with any ethical obligations in their rendering of legal services
Workers’ Compensation FAQ Brochure– We designed this brochure as a guide to frequently asked questions about workers’ compensation. This sample brochure is provided for your information only. The template must be customized to each member before implementation. Please contact us for assistance.
LWP Instructions for Online 5020– This users guide offers a step-by-step approach to completing and submitting an Employer’s First Report of Injury (Form 5020) using LWP’s secure loss reporting portal.
Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who receive settlements, judgments, awards or other payment from liability insurance (including self-insurance), no-fault insurance, or workers’ compensation, collectively referred to as Non-Group Health Plan (NGHP) or NGHP insurance. The purpose of the Medicare Secondary Payer Act is to protect Medicare’s interests by making Medicare secondary to all other medical coverage when an injured person receives — or may receive — Medicare benefits. What previously applied to group health plans (GHP) and workers’ compensation, now applies to all forms of payers including pools like CIRA and all of its members individually. More information about Mandatory Insurer Reporting can be found on the Centers for Medicare & Medicaid Services (CMS) website.
If your agency issues payments to any injured person, either directly or through your TPA, you are considered a Responsible Reporting Entity (RRE) and must register with CMS. Neither your TPA nor CIRA can register as the RRE on your behalf. For claims involving existing or potential Medicare beneficiaries, there is no dollar minimum and nuisance settlements are not excluded. The compliance trigger is ANY payment made to a Medicare-eligible person.
CIRA coordinates with its third-party claims administrators to report payments to CMS on our members’ behalf. As a result, registering and maintaining status as an RRE is the only step members need to take. It is imperative that members ensure their Profile Report is re-certified annually to enable reporting. This primarily applies to liability program members as all workers’ compensation payments are issued by CIRA.