Through a blend of self-insurance and excess insurance, ICRMA provides statutory workers’ compensation coverage to Program members. Members pay an annual contribution based on actuarially determined losses, administrative expenses, and excess insurance. The Workers’ Compensation Program Manager provides claims oversight, conducts periodic claim file reviews, reports losses to the excess carrier, and reviews the performance of the program TPA. Click the following to view the Workers’ Compensation 2021-22 Memorandum of Coverage.
Because each public agency has a unique risk appetite, members can determine how much risk they are willing to accept by selecting a member retained limit of $350,000, $500,000, $750,000, $1 million, or higher. The ICRMA pooled retention is $1.25 million for the 2021-2022 program year. The chart below shows how the various loss layers are funded from the members’ retentions through the excess insurance.
Click the following for the most recent Workers’ Compensation program actuarial report.
Report a Workers’ Compensation Claim
Workers’ Compensation claims should be reported directly to AdminSure, ICRMA’s third-party claim administrator (TPA), within two working days of knowledge of the incident or injury. Reportable claims may be submitted online at http://www.adminsure.com. Please contact AdminSure directly at (909) 861-0816 for any claims administration questions.
Member employees are required to report any work-related incident or injury to the Company Nurse Triage Hotline at (877) 223-9310. More information below.
View the MOC for Workers’ Compensation claim reporting requirements. Claims meeting these requirements should be reported as soon as possible to ICRMAwcprogram@adminsure.com. If you have questions, please contact ICRMA’s Workers’ Compensation Manager, Kristen Vanscourt. The Workers’ Compensation Program Manager will be responsible for reporting to the excess insurer(s).
Third Party Administrators
ICRMA’s Governing Board has adopted performance standards for the Workers’ Compensation TPA to ensure appropriate claims handling. Following are some helpful documents:
- Workers’ Compensation TPA Performance Standards (revised 4/9/20)
- Claim Reporting / Status Update Form
- Settlement Request Form
Defense Panel
ICRMA’s Governing Board has adopted Litigation Management Policies and Procedures to ensure appropriate claims handling. Following is a link to the document:
- Litigation Management Policies and Procedures
- Workers’ Compensation Approved Defense Panel – refer to members only section of the website
Should you require use of the appendices they are listed below:
- Appendix B: Engagement Letter (TPA Adjusters)
- Appendix C: Case Analysis (Defense Panel)
- Appendix D: Budget (Defense Panel)
Nurse Triage
When an employee is injured, he/she is instructed by the member to call the Nurse Triage line at (877) 223-9310. A registered nurse completes a series of triage questions which will determine whether or not a medical referral to the city’s industrial clinic needs to be made. A copy of the report generated by the nurse is e-mailed to the City contact, ICRMA’s program manager, and to the city’s TPA.
Cal/OSHA
Cal/OSHA recently confirmed that California employers must electronically report injury and illness data via federal OSHA Injury Tracking Application (ITA) online portal. Please reference:
https://www.dir.ca.gov/dosh/calosha-updates/log300-reporting.html
https://www.osha.gov/news/newsreleases/trade/04302018
OSHA Rule on Electronic Reporting
Federal OSHA Injury Tracking online portal: https://www.osha.gov/injuryreporting/index.html. This link provides all the details regarding this employer requirement. Reference ITA Job Aids.